Ankle Exercise Research Articles

Affordable web-based foot–ankle exercise program proves effective for diabetic foot care in a randomized controlled trial with economic evaluation

The aim of this study was to shed light on a crucial issue through a comprehensive evaluation of the cost-effectiveness and cost-utility of a cutting-edge web-based foot–ankle therapeutic exercise program (SOPeD) designed for treating modifiable risk factors for ulcer prevention in individuals with diabetes-related peripheral neuropathy (DPN). In this randomized controlled trial, 62 participants diagnosed with DPN were assigned to the SOPeD software or received usual care for diabetic foot. Primary outcomes were DPN symptoms and severity, foot pain and function, and quality-adjusted life years (QALYs). Between-group comparisons provided 95% confidence intervals. The study also calculated incremental cost-effectiveness and cost-utility ratios (ICERs), analyzed direct costs from a healthcare perspective, and performed a sensitivity analysis to assess uncertainty. The web-based intervention effectively reduced foot pain, improved foot function and showed favorable cost-effectiveness, with ICERs ranging from (USD) $5.37–$148.71 per improvement in different outcomes. There is a high likelihood of cost-effectiveness for improving DPN symptoms and severity, foot pain, and function, even when the minimum willingness-to-pay threshold was set at $1000.00 USD. However, the intervention did not prove to be cost-effective in terms of QALYs. This study reveals SOPeD's effectiveness in reducing foot pain, improving foot function, and demonstrating cost-effectiveness in enhancing functional and clinical outcomes. SOPeD stands as a potential game-changer for modifiable risk factors for ulcers, with our findings indicating a feasible and balanced integration into public health systems. Further studies and considerations are vital for informed decisions to stakeholders and the successful implementation of this preventive program on a larger scale.Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Usability of the novel ankle training equipment with spring resistance-based plantar press exercises in the standing position: A focus on chronic stroke patients with hemiplegic gait.

To improve gait disability in patients with chronic stroke, ankle muscle strengthening and calf muscle stretching exercises are required. However, currently available ankle training equipment limit ankle exercises based on the position. Recently developed ankle training equipment enables spring resistance-based plantar press exercises to be performed in the standing position with weight support. To conduct a usability test of the ankle training equipment in the standing position by stroke patients with hemiplegic gait and verify its effects on ankle movements. The ankle training equipment was applied to five patients with chronic stroke and hemiplegic gait. In the standing position, the patients performed forefoot and rearfoot press exercises in the affected side with a day's interval at 20 repetitions maximum (RM). During the exercises, surface electromyography (sEMG) was used to measure the maximum voluntary isometric contraction (%MVIC) of the leg muscles. The System Usability Scale (SUS) was used to assess the ankle training equipment. Wilcoxon signed-rank test was used to evaluate the differences in muscle activity between the two exercises. Forefoot and rearfoot press exercises increased the %MVIC in the biceps femoris. Additionally, the tibialis anterior and medial gastrocnemius activity was significantly different between the two exercises. The SUS was 78.75% (SD 12.7). The usability test of the passive-control foot press trainer (PFPT) that with improvements in the structure and functions for convenience, it could be commercialized. PFPT could be an alternative to the ankle rehabilitation robot that necessitates a sitting position.

Effect of Dry Needling in Patients with Plantar Fasciitis in Reducing Pain Compared to Ultrasound Therapy

Background: Pain and discomfort below the medial calcaneal tubercle especially in the weight-bearing areas arethe hallmarks of plantar fasciitis heel pain. It affects about 10% of people in the general population and affectsabout 83% of active working individuals between the ages of 25 and 65.Purpose: To determine the effect of dry needling therapy on subjects with Plantar fasciitis in reducing pain andincreasing Ankle Range Of Motion (ROM) when compared to Ultrasound therapy with ankle exercises.Materials and Methods: The subjects were selected according to selection criteria. All the subjects were assessedusing Numeric Pain Rating Scale (NPRS) and Ankle ROM. A sample of 50 (45 females and 5 males) was taken forthe study which was further divided into two groups where the experimental group received Dry needling therapywith ankle exercises (n=25) and the control group received Ultrasound therapy with ankle exercises (n=25). Theintervention was given for two weeks. The entire process was performed from November 2022 to April 2023.Result: Statistical analysis showed that there was a significant difference obtained within the groups of pre andpost-test for NPRS and ROM (p<0.0001). A significant difference was obtained between the experimental andcontrol groups for NPRS and ROM (p<0.0001).Conclusion: Dry needling therapy with ankle exercises was more beneficial in reducing pain than ultrasoundtherapy with ankle exercises in Plantar fasciitis subjects.

Impact of lower limb movements on iliac vein stenting in iliac vein compression syndrome patients: insights from computational modeling.

Purpose: Iliac vein stenting is the primary treatment for patients with iliac vein compression syndrome (IVCS). However, post-stent placement, patients often experience in-stent restenosis and thrombosis. Despite this, the role of lower limb movements in the functioning of stents and veins in IVCS patients remains unclear. This study aimed to address this knowledge gap by developing a computational model using medical imaging techniques to simulate IVCS after stent placement. Methods: This research used a patient-specific model to analyze the effects of lower extremity exercises on hemodynamics post-stent placement. We conducted a comprehensive analysis to evaluate the impact of specific lower limb movements, including hip flexion, ankle movement and pneumatic compression on the hemo-dynamic characteristics within the treated vein. The analysis assessed parameters such as wall shear stress (WSS), oscillatory shear index (OSI), and residence time (RRT). Results: The results demonstrated that hip flexion significantly disrupts blood flow dynamics at the iliac vein bifurcation after stenting. Bilateral and left hip flexion were associated with pronounced regions of low WSS and high OSI at the iliac-vena junction and the stent segment. Additionally, active ankle exercise (AAE) and intermittent pump compression (IPC) therapy were found to enhance the occurrence of low WSS regions along the venous wall, potentially reducing the risk of thrombosis post-stent placement. Consequently, both active joint movements (hip and ankle) and passive movements have the potential to influence the local blood flow environment within the iliac vein after stenting. Conclusions: The exploration of the impact of lower limb movements on hemodynamics provides valuable insights for mitigating adverse effects associated with lower limb movements post iliac-stenting. Bilateral and left hip flexions negatively impacted blood flow, increasing thrombosis risk. However, active ankle exercise and intermittent pump compression therapies effectively improve the patency.

Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study

BackgroundMirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. Objectiveidentify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy Design3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SettingParticipants’ homes (intervention) and a movement analysis laboratory (measures). ParticipantsAdults discharged from statutory stroke rehabilitation services. InterventionMirror movement therapy ankle exercises. Outcome measuresMotricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). ResultsFive cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped ConclusionThe identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. Clinical Trial Registration numberNCT04339803 (ClinicalTrials.gov) Contribution of the PaperThis early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.

Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial.

Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually or combined. This randomized trial was conducted between December 1st, 2018, and May 15th, 2019, at Gazi University, Department of Physiotherapy and Rehabilitation. Randomly assigned into groups were 27 independently ambulant patients with unilateral/bilateral SCP, where PFEs were applied to the DF, PF, or DPF muscles. Muscle tone, balance, and functional mobility were assessed. The MVC was evaluated by surface electromyography. PFEs were performed 4 times a week, for 6 weeks. The spasticity of the PF muscles decreased in all of the groups. PFE of the DF muscles led to an increase in ankle joint range of motion (ROM) and improved functional mobility (p < 0.05). PFE of the PF muscles resulted in improvements in balance and functional mobility (p < 0.05). PFE of the DPF muscles brought about improvements in balance but not in functional mobility (p < 0.05). No significant difference in the MVC was observed in any of the groups (p > 0.05). Gains are obtained according to the function of a muscle group. By training the DF muscles, it is possible to improve function and ROM. Furthermore, training the PF muscles led to improvements in balance and functional mobility, indicating that it is possible to bring about positive changes in spastic muscles. This study showed that muscle groups must be exercised according to the intended goal.

Efektifitas Otago Exercise Dan Ankle Exercise Terhadap Penurunan Resiko Jatuh Pada Lansia

The risk of falling can be a serious complication in the elderly because falls in the elderly can cause serious injury and disability. Handling that can be applied to reduce the risk of falling is by otago and ankle exercises. The purpose of this study was to analyze the effectiveness of otago and ankle exercises on reducing the risk of falling in the elderly in Tegalsiwalan Village, Tegalsiwalan, Probolinggo.This type of research is a pre experimental design with a pre post design approach. The population of 40 people with 36 respondents who met the inclusion requirements of the study, were selected by purposive sampling technique. The berg balance scale obsevatio sheet is the tool employed, and the data is subsequently gathered using the editing, coding, scoring and tabulating processes. The data obtained were analyzed using the Chi square and the Wilcoxon hypothesis test in both groups. The results showed that the p value was 0.002 in the group given the otago exercise and the p value was 0.014 in the group given the ankle exercise. For the comparison test, the value of sig(2-tailed) was 0.245 &gt; 0.05. So there is no difference between otago exercise and ankle exercise in reducing the risk of falling in the elderly.The next researcher gave the same intervention both for group one and group two. So that further researchers can combine these two interventions, so that the result are maximized. &#x0D; &#x0D;

Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance.

To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p=0; I2 =0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p=0.21, I2 =51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.

Effect of Ankle Exercises in Preventing Ankle Sprain in Amateur Football Players: A Follow-up Study

Purpose: A lateral ligament complex injury to the ankle joint affects around 1 out of every 10,000 persons every day, accounting for a quarter of all sports injuries. As a result, injury prevention initiatives aimed at adolescents may have a greater influence on player health in the future. Materials and Methods: 74 people were screened, and 60 were chosen based on inclusion criteria to participate in the study. A total of 60 football players were separated into two groups, each with 30 players. Players between the ages of 10 and 15 years who had been practicing for at least 6 months were included, while players with previous ankle sprain injuries, as well as previous neurological and musculoskeletal problems, were excluded. The range of motion of the ankle joint was measured and demographic data were gathered. The Star Excursion Balance Test (SEBT) was utilized as an end measure before the exercise program, after 4 weeks, and after 6 months of follow-up. Conventional exercises along with a conventional ankle exercise program were given to the two groups. Results: The severity of injuries in the experimental group was mild to moderate, whereas it was moderate to severe in the control group. The experimental group’s SEBT reach distance improved considerably after 4 weeks and 6 months of follow-up (p0.00001), but the control group’s improvement was not significant after 4 weeks. The control group showed considerable improvement after 6 months of follow-up except for anteromedial and posterolateral directions. Conclusion: The difference in SEBT reach distance between the two groups was significant in all directions; however, there was no significant difference in medial reach when the difference between the two groups was compared at post 4 weeks and 6 months.

IS MULLIGAN CONCEPT EFFECTIVE TREATMENT FOR CHRONIC PLANTAR FASCIITIS? A RANDOMIZED CONTROLLED TRIAL

Plantar fasciitis (PF) is one of the widespread conditions causing hindfoot pain. The most common presenting symptoms are functional limitation and pain (first step and activity) on plantar surface of the foot. The non-operative treatments provide complete resolution of pain in 90% of patients, but functional limitation still remains as a risk factor for recurrency of PF. Although the number of non-operative treatment options showing efficacy on pain and functional limitation are excessive, the evidences are limited for functional limitation. Additionally, Mulligan mobilization with movement (MMWM) in Chronic Plantar Fasciitis has been poorly studied in the literature. According to these findings, the study was aimed to determine effectiveness of Mulligan mobilization with movement on Chronic Plantar Fasciitis.A total of 25 patients (40 feet) with chronic PF were included in the study. The patients were randomly divided into Mulligan concept rehabilitation group (PF-M, n=20 feet) and Home Rehabilitation group (PF-H, n=20 feet). (MMWM), Foot and ankle exercises program were applied to PF-M, twice a week totally 8 week (16 sessions) and foot- ankle exercises as a home program were given for PF-H, 8 weeks. The range of motion (ROM) for dorsiflexion and plantar flexion was measured by using a manual goniometer. Pain, disability and activity restriction were assessed by Foot Function Index (FFI) . The first step morning pain was evaluated by Visual Analogue Scale (VAS) and Kinesiophobia was also reported by using Tampa Scale (TSK). Patients were evaluated at baseline and 8 weeks.FFI, VAS, TSK, ROM values improved in all groups (intragroup variability) at 8th week (P &lt; .05). The other result indicated that ROM values for DF and PF and TSK scores in PF-M had more significant improvement than PF-H (p&lt;.05).To the best of our knowledge this is the first randomised controlled trial for investigating Mulligan Concept efficiancy on chronic PF. Both Mulligan mobilization with movement (MMWM) and exercise protocols are effective for chronic PF. Furthermore, The Mulligan concept seems more effective treatment option in reducing kinesiophobia and improving functional capacity.

손목 관성센서를 사용한 발목 피로로 유발된 발목불안정성의 평가

Existing measurement tools that can evaluate ankle instability have some limitations such as subjectivity and lack of reliability. This study is to address such limitations by assessing ankle instability objectively using an inertial sensor during the Y-balance test used in the field.BR Sixteen healthy young males (25.4±2.5 yrs) performed Y-balance test twice pre and post fatigue on the force plate. To induce the fatigue in the ankle joint, calf raises were repeated 50 times with maximal effort. During the Y-balance test, reach distances and subjective ankle instability/fatigue were measured. An inertial sensor attached to the participant’s waist was used to collect 3-direction linear and angular accelerations. Root-mean-square (RMS) value of linear acceleration, 95EV (95% ellipsoid volume), and total distance of the center of pressure (TCOP) were calculated. Dependent t-tests were used to compare dependent variables pre and post fatigue.BR Subjective ankle instability/fatigue (Pre vs. Post; p=.031, p=.002 respectively), and RMS values of linear and angular acceleration for the posterior-lateral direction of reach were increased (P-values .02~.04) post-fatigue. However, there were no significant differences in the reach distances and 95EV for all directions. These findings show that measures derived from a wrist-mounted inertial sensor can capture the altered ankle instability induced by fatiguing ankle exercise which is not identified by the Y-balance test only used in the field. This suggests that a wrist-mounted inertial sensor may help provide more accurate evaluation of ankle instability in the clinical and sports settings.

The Effect of Custom Insoles on Muscle Activity in Diabetic Individuals with Neuropathy

Foot ulcers are amongst the most serious complications of diabetes. Guidelines recommend that people with diabetes wear appropriate footwear or insoles to reduce repetitive stresses. Excessive plantar pressure has been recognized as the major risk factor for plantar ulcers in diabetic individuals; custom insoles are indicated as the gold standard treatment to unload the foot structure. The aim of this study was to investigate the effect of custom insoles on biomechanical and neuromuscular functions in diabetic neuropathic individuals. Ten diabetic subjects walked with and without custom insoles at their preferred speed; ten controls were assessed for comparison. Data were captured through seven video cameras, plantar pressure insoles, and surface electromyography. The electrical activity of Rectus Femoris, Tibialis Anterior, Medius Gluteus and Gastrocnemius Lateralis were acquired bilaterally. The plantar pressure and surface electromyographic variables were determined, while videos were used to detect the gait cycle. The following comparisons were made across the variables through the non-parametric SPM1D test (p &lt; 0.05): condition with vs. without insoles vs. controls. Custom insoles provided a reduction in plantar pressure through contact surface redistribution in association with a reduced electromyographic activity. Our results suggest optimizing the prevention approach by including personalized foot and ankle exercises.

Effects of a Home-Based Foot–Ankle Exercise Program with Educational Booklet for Foot Dysfunctions in People with Diabetic Neuropathy: Results of the FOCA-II Randomized Controlled Clinical Trial

Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot–ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot–ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 ± 6.4 years, 23.5 ± 4.8 kg/m2, males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 ± 9.4 years, 22.9 ± 3.6 kg/m2, males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (p = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect p = 0.020, mean difference = -64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (p = 0.007) and for the knee and hip at push off over 8 and 16 weeks (p &lt; 0.001 and p = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot–ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot–ankle kinematics and kinetics.

Could an Internet-Based Foot-Ankle Therapeutic Exercise Program Modify Clinical Outcomes and Gait Biomechanics in People with Diabetic Neuropathy? A Clinical Proof-of-Concept Study.

Previous studies have shown the efficacy of foot-ankle exercises in people with diabetic peripheral neuropathy (DPN), but the quality of evidence is still low. This proof-of-concept study pursues preliminary evidence for potential clinical and gait biomechanical benefits from an internet-based foot-ankle therapeutic exercise program for people with DPN. We randomized 30 individuals with DPN (IWGDF risk category 1 or 2) into either the control group (CG) receiving the usual care or the intervention group (IG) receiving the usual care plus an internet-based foot-ankle exercise program, fully guided by the Sistema de Orientação ao Pé Diabético (SOPeD; translation: Diabetic Foot Guidance System) three times per week for 12 weeks. We assessed face-to-face clinical and biomechanical outcomes at baseline, 12 weeks, and 24 weeks (follow up). Participants had good adherence to the proposed intervention and it led to only mild adverse events. The IG showed improvements in the ankle and first metatarsophalangeal joint motion after 12 and 24 weeks, changed forefoot load absorption during foot rollover during gait after 24 weeks, reduced foot pain after 12 weeks, and improved foot function after 24 weeks. A 12-week internet-based foot-ankle exercise program using the SOPeD software (version 1.0) has the potential to reduce foot pain, improve foot function, and modify some important foot-ankle kinematic outcomes in people with DPN.

Expanding the Clinical and Genetic Spectrum of Caveolinopathy in Korea

Purpose: Caveolinopathy is a disease caused by caveolin-3 (CAV3) mutations that shows a wide clinical spectrum, including isolated hyperCKemia and limb-girdle muscular dystrophy. While recent advances in next-generation sequencing (NGS) have enabled earlier diagnosis of this disease, it remains difficult to predict the clinical course of each patient.Methods: This study summarizes the clinical presentations of 13 genetically confirmed caveolinopathy patients in four Korean families. Genetic diagnosis was performed using NGS technologies for probands and Sanger sequencing for the other family members.Results: Four coding mutations were found (p.Val103_Val104del, p.Asp28Glu, p.Pro105Leu, and p.Arg27Gln), and each family showed autosomal dominant inheritance. While all 13 cases had hyperCKemia, only five of them showed some myopathic features including ankle contracture, calf hypertrophy, exercise intolerance, and muscle cramping. This high proportion of asymptomatic cases suggests both that these mutations may be associated with a mild phenotype and that caveolinopathy may be an underdiagnosed disease.Conclusion: This study extends our understanding of caveolinopathy; in particular, the findings suggest the need to consider caveolinopathy in patients with incidental findings of CK elevation. NGS may be a useful method in the differential diagnosis of such cases.

Knowledge about foot-specific foot falls risk factors and exercise among physiotherapists in the UK and Portugal: A cross-sectional survey.

Background and purposeFoot‐related falls risk factors and specific foot and ankle exercise interventions are within the scope of Physiotherapy, yet little is known about United Kingdom (UK) and Portugal‐based (PT) physiotherapists' self‐perceived knowledge, confidence and practice of such interventions, or perceptions of patients' falls prevention knowledge. The purpose of this study was to assess levels of self‐reported knowledge, confidence, and practices surrounding foot‐specific falls risk and exercise for fall prevention in physiotherapists working in the UK and in Portugal. It also aimed to explore physiotherapists' views about their participants' falls prevention knowledge.MethodsA self‐report online survey was developed, and pilot tested in both nations. Registered Physiotherapists were invited to participate through their professional associations, social media and snowballing. Mann‐Whitney tests were used to compare mean ranks of ordinal variables between nations and Chi‐square test to assess the independency between pairs of variables. Spearman's correlation coefficient (rs) was used to measure the association between pairs of variables (p < 0.05).Results682 physiotherapists participated in the survey [UK n = 229 (mean (SD) age = 43(10) years, 86.9% female]; PT n = 453 (mean (SD) age = 33(9) years, 78.3% female]. Among physiotherapists with a caseload of ≥70% older adults, more PT‐based physiotherapists held postgraduate qualifications (p = 0.01). Most physiotherapists correctly identified generic and foot‐specific risk factors (≥70% of participants for each item). More UK‐based physiotherapists reported always prescribing ankle and foot exercises (42.6% vs. 33%, p =< 0.001) and displayed higher levels of self‐reported confidence surrounding exercise‐based interventions.DiscussionOur sample of UK and Portugal‐based physiotherapists are aware of the contribution of foot‐specific risk factors and exercise to falls prevention, with the former group being more confident in exercise‐based interventions. Both groups of physiotherapists perceived that their older patients had little knowledge about these topics, with UK older adults having slightly better knowledge on generic falls risk factors at first contact. Future studies and strategies for knowledge translation and education in foot health and foot function screening and management for physiotherapists, within a falls prevention scope, may be informed by this study.

Sex differences in central and peripheral fatigue induced by sustained isometric ankle plantar flexion

The main aim of this study was to determine sex differences in central and peripheral fatigue produced by a sustained isometric exercise of ankle plantar flexors in healthy young adults. Ten males and fourteen females performed a sustained isometric ankle exercise until task failure. Maximal voluntary isometric contraction (MVIC) torque (plantarflexion), voluntary activation level (using the twitch interpolation technique), and resting twitch contractile properties [twitch peak torque (ST), twitch half relaxation time, and low frequency fatigue (LFF) ratio] were measured before, immediately after, and throughout a recovery period (1, 2, 5, and 10 min) following the exercise protocol in order to characterize neuromuscular fatigue. Fatigue had effects (p≤ 0.05) on all dependent variables (reduction in MVIC, VA and twitch torque and slowing of relaxation time). However, no significant differences in performance fatigability markers (MVIC torque decline and time to fatigue) and only minor differences in the variables reflecting central and peripheral fatigue mechanisms were found between males and females. A regression analysis did suggest a somewhat greater role of central fatigue in males compared with females. Females also showed a slightly greater and more prolonged decline in ST and LFF after exercise compared with males. The presence of only minor differences in central and peripheral fatigue mechanisms between males and females in the present study could be explained by the lack of important sex differences in performance fatigability, which could be due to lesser sex differences in the relative area of type I muscle fibers and in contractile function (muscle strength) of ankle plantar flexors as compared with other muscle groups.

Foot–ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial

This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN.Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).

A novel device for lower leg intermittent pneumatic compression synchronized with active ankle exercise for prevention of deep vein thrombosis.

Intermittent pneumatic compression devices (IPCDs) and active ankle exercises have been shown to be efficacious in preventing venous thromboembolism (VTE) by increasing venous flow velocity and volume. However, IPCDs are expensive and require electricity; therefore, they cannot be used in the event of power loss. We developed a non-powered device that provides lower leg intermittent pneumatic compression synchronized with AAEs (LISA) and compared its efficacy with AAEs alone in increasing the peak velocity in the femoral vein. The study population consisted of 20 healthy younger men and 20 healthy older men who performed AAE every 2s in a sitting posture under four conditions: AAE with LISA (AAE+LISA), AAE alone (AAE), AAE with IPCD, and AAE with a graduated compression stocking. The PVs under all conditions were significantly higher than those at rest. The PVs in the AAE+LISA condition were significantly higher than those in the AAE alone condition in both younger and older groups (both p < .001). AAE with LISA significantly increased the PV, suggesting that LISA might be useful for preventing DVT.

Effects of Weight-bearing Exercise on a Mini-trampoline, and Foot-ankle Therapeutic Exercise Program on Foot-ankle Functionality in People With Diabetic Peripheral Neuropathy

Purpose: This study aims to investigate and compare the efficacy of two training programs of weight-bearing on a mini-trampoline, and ankle exercise therapy on foot-ankle functionality in people with peripheral neuropathy. Methods: The present research is a clinical trial study that has been conducted using two intervention groups and one control group. The statistical population of this study includes 48 women living in Tehran City, Iran with type 2 diabetes and moderate or severe neuropathy. The Michigan neuropathy screening instrument (MNSI) and foot health status questionnaire (FHSQ-BR) were used to collect data. The first experimental group performed mini-trampoline exercises, while the second group performed ankle therapeutic exercises at home for eight weeks. Data were analyzed using analysis of covariance (ANOVA) and correlated t-test. Results: The findings showed that mini-trampoline exercise and ankle exercise therapy had a significant effect on relieving foot pain (P&lt;0.05), as well as improving foot functionality (P&lt;0.05) and overall foot health (P&lt;0.05) in both intervention groups compared to the control group. Also, the results showed that ankle exercise therapy was more effective than mini-trampoline exercise in two variables of foot pain and foot functionality (P&lt;0.05). Both training programs showed significant effects on the ankle range of motion (P&lt;0.05), while, no significant difference was observed between the two intervention groups for the range of motion of the ankle (P&lt;0.05). Moreover, mini-trampoline exercise and ankle exercise therapy revealed a significant effect on the range of motion of the metatarsophalangeal joints compared to the control group (P&lt;0.05). In the range of motion of dorsiflexion of the right foot, mini-trampoline exercises were more effective than therapeutic exercises, while regarding the variable of dorsiflexion of the left foot, the effectiveness of ankle training intervention was more than trampoline (P&lt;0.05). Both trampoline exercise and ankle therapeutic exercise interventions had a significant effect on ankle strength, but no difference was observed in plantar flexion strength of the right foot between the two intervention groups. However, the mini-trampoline intervention was more effective than the ankle exercise therapy intervention for the three variables of the hallux dorsiflexion strength of the hallux and plantar flexion strength of the left foot (P&lt;0.05). Both training interventions were effective on the variable of right and left hallux flexion strength (P&lt;0.05). The efficacy of none of the two interventions on the right and left hallux extension strength was confirmed; the effectiveness of both interventions on the right and left hallux flexion strength was similar and no significant difference was observed (P&gt;0.05). No significant difference was found in the control group after 8 weeks for the relevant variables (P&gt;0.05). Conclusion: Exercises on the mini-trampoline and ankle therapeutic exercises at home can be effective in improving patients’ quality of life as a simple, affordable, low-risk, and quick-improvement treatment program that focuses on the use of segmental exercises for foot functionality.