Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT.

IF 2.5 3区医学 Q1 ORTHOPEDICS Journal of Foot and Ankle Research Pub Date : 2023-12-06 DOI:10.1186/s13047-023-00690-4

Vasileios Lepesis, Joanne Paton, Alec Rickard, Jos M Latour, Jonathan Marsden

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Abstract

Introduction: People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs.

Design and methods: Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1^st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance.

Results: At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%).

Conclusions: Combining ankle and 1^st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk.

Trial registration: https://classic.

Clinicaltrials: gov/ct2/show/NCT03195855 .

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糖尿病周围神经病变患者足部和踝关节活动结合家庭伸展的效果:一项概念验证的随机对照试验。

糖尿病周围神经病变(DPN)和关节活动受限综合征(LJMS)患者可经历前足峰值足底压力(PPPs)增加，这是溃疡的已知危险因素。本研究的目的是调查DPN患者的踝关节和第一跖趾(MTP)关节活动和家庭拉伸是否能改善关节活动范围(ROM)并减少前足PPPs。设计和方法:61名DPN患者(IWGDF风险2)，随机分配到6周的踝关节和第一MTP关节活动计划(n = 31)和家庭拉伸或标准护理计划(n = 30)。基线(T0);干预后6周(T1)和随访3个月(T2)，盲法评估者通过3D (Codamotion)运动分析和负重弓步测试记录动态踝关节背屈范围，静态第1 MTP关节背屈ROM，动态足底压力和平衡。结果:在T1和T2时，两组在站立阶段的踝关节背屈、足底压力和平衡方面无差异。与对照组相比，干预组在6周(T1)和18周(T2)时的静态踝关节背屈范围(左侧1.52 cm和2.9cm，右侧1.62 cm和2.7 cm)分别有统计学意义上的显著增加。结论:在DPN患者的6周计划中，将踝关节和第一MTP关节活动与家庭拉伸相结合，可以有效地增加静态范围。这种干预可能有助于改善糖尿病和神经病变患者的踝关节、拇关节活动度和前后位稳定性限制，但对降低PPP或足部溃疡风险无效。试验报名:https://classic.Clinicaltrials: gov/ct2/show/NCT03195855。

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来源期刊

Journal of Foot and Ankle Research ORTHOPEDICS-

CiteScore

4.50

自引率

10.30%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Foot and Ankle Research, the official journal of the Australian Podiatry Association and The College of Podiatry (UK), is an open access journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. Journal of Foot and Ankle Research covers a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submissions from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. The Australian Podiatry Association and the College of Podiatry (UK) have reserve funds to cover the article-processing charge for manuscripts submitted by its members. Society members can email the appropriate contact at Australian Podiatry Association or The College of Podiatry to obtain the corresponding code to enter on submission.