Abstract
BackgroundHigher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength. Therefore, in this randomised controlled trial we evaluated whether lower-extremity strength training can reduce plantar pressures in diabetic polyneuropathy.MethodsThis study was embedded in an unblinded randomised controlled trial. Participants had diabetes and polyneuropathy and were randomly assigned to the intervention group (n = 48) receiving strength training during 24 weeks, or the control group (n = 46) receiving no intervention. Plantar pressures were measured in both groups at 0, 12, 24 and 52 weeks. A random intercept model was applied to evaluate the effects of the intervention on peak pressures and pressure–time-integrals, displacement of center-of-pressure and the forefoot to rearfoot pressure–time-integral-ratio.ResultsPlantar pressure patterns were not affected by the strength training. In both the intervention and control groups the peak pressure and the pressure–time-integral under the forefoot increased by 55.7 kPa (95% CI: 14.7, 96.8) and 2.0 kPa.s (95% CI: 0.9, 3.2) over 52 weeks, respectively. Both groups experienced a high number of drop-outs, mainly due to deterioration of health status and lower-extremity disabilities.ConclusionsPlantar pressures under the forefoot increase progressively over time in people with diabetic polyneuropathy, but in this study were not affected by strength training. Future intervention studies should take this increase of plantar pressure into account and alternative interventions should be developed to reduce the progressive lower extremity problems in these patients.Trial registrationThis study was embedded in a clinical trial with trial number NCT00759265.
Highlights
Higher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength
In patients with Diabetic polyneuropathy (DPN), especially the region of the forefoot is at higher risk due to deformities and altered gait patterns; higher loading of these areas has been associated with the development of plantar ulceration [2,5]
We observed close correlations between the plantar flexion moment at the first part of the stance phase, the rate of forward progression of the center-of-pressure and loading of the forefoot [12]. These results suggest that the decreased muscle strength due to DPN [13,14] can contribute to adverse plantar pressures
Summary
Higher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength. In this randomised controlled trial we evaluated whether lowerextremity strength training can reduce plantar pressures in diabetic polyneuropathy. Most preventive strategies aim to reduce the abnormal loading of the foot in patients at risk by prescribing offloading footwear and aids like shoe inlays [6] These interventions do not correct the underlying pathology and mixed results have been obtained [7]
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