SLR - October 2023 - Burachek
Title: Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trialReference: Monteiro RL, Ferreira JSSP, Silva ÉQ, Cruvinel-Júnior RH, Veríssimo JL, Bus SA, Sacco ICN. Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trial. Braz J Phys Ther. 2023 May-Jun;27(3):100517. doi: 10.1016/j.bjpt.2023.100517. Epub 2023 Jun 12. PMID: 37348358; PMCID: PMC10314233.
Level of Evidence: Level II
Reviewed By: Anna-Maria Burachek
Residency Program: Montefiore Medical Center – Bronx, NY
Podiatric Relevance: This article investigates the benefits of a foot-ankle therapeutic exercise program for patients with diabetic neuropathy (DPN), which is a condition commonly treated by podiatric physicians.
Methods: The study included 66 participants diagnosed with DPN, randomly divided into a control group and an intervention group. The control group received standard care for DPN, while the intervention group received the standard care along with a 12-week group-based foot-ankle exercise program. Outcomes were measured at baseline and after 12 weeks by blinded assessors, allowing for a comparison between the groups.
Results: After 12 weeks, the intervention group (IG) showed differences compared to the control group (CG). The IG exhibited a greater hip extensor moment at push-off and a larger hallux contact area. Within the IG, changes were observed from baseline to 12 weeks, including an increase in arch height during stance and higher peak pressure and pressure-time integral at the central forefoot region. However, no significant differences were found in foot-ankle kinematics or other joint moments related to overall limb biomechanics. The findings suggest that the 12-week foot-ankle exercise program primarily influenced specific aspects of foot and hip mechanics.
Conclusions: The study indicates that a 12-week group-based foot-ankle exercise program for individuals with DPN had positive effects on certain aspects of foot mechanics. It led to improvements in hip moment at push-off, indicating enhanced propulsion during gait, and increased hallux surface contact area, suggesting greater toe involvement in foot rollover. However, broader improvements in foot-ankle biomechanics and pressure distribution may require individualized, longer-term, and more intensive interventions. The overall impact of the 12-week exercise program on foot-ankle mechanics and pressure distribution was limited beyond the observed changes in the hip and hallux. These findings highlight the potential benefits of targeted foot-ankle exercises for individuals with DPN, particularly in terms of propulsion and toe involvement, and emphasize the need for further research and interventions to address other aspects of foot-ankle biomechanics and pressure distribution.