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Open Access 01-12-2013 | Research

Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial

Auteurs: Tom Melai, Nicolaas C Schaper, T Herman IJzerman, Ton LH de Lange, Paul JB Willems, Valéria Lima Passos, Aloysius G Lieverse, Kenneth Meijer, Hans HCM Savelberg

Gepubliceerd in: Journal of Foot and Ankle Research | Uitgave 1/2013

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Abstract

Background

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. Therefore, in this randomised controlled trial we evaluated whether lower-extremity strength training can reduce plantar pressures in diabetic polyneuropathy.

Methods

This 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.

Results

Plantar 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.

Conclusions

Plantar 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 registration

This study was embedded in a clinical trial with trial number NCT00759265.
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Literatuur
1.
go back to reference Allet L, Armand S, Golay A, Monnin D, de Bie RA, de Bruin ED: Gait characteristics of diabetic patients: a systematic review. Diabetes Metab Res Rev. 2008, 24 (3): 173-191. 10.1002/dmrr.809.CrossRefPubMed Allet L, Armand S, Golay A, Monnin D, de Bie RA, de Bruin ED: Gait characteristics of diabetic patients: a systematic review. Diabetes Metab Res Rev. 2008, 24 (3): 173-191. 10.1002/dmrr.809.CrossRefPubMed
2.
go back to reference Caselli A, Pham H, Giurini JM, Armstrong DG, Veves A: The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care. 2002, 25 (6): 1066-1071. 10.2337/diacare.25.6.1066.CrossRefPubMed Caselli A, Pham H, Giurini JM, Armstrong DG, Veves A: The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care. 2002, 25 (6): 1066-1071. 10.2337/diacare.25.6.1066.CrossRefPubMed
3.
go back to reference Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990, 13 (5): 513-521.CrossRefPubMed Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990, 13 (5): 513-521.CrossRefPubMed
4.
go back to reference Valk GD, Kriegsman DM, Assendelft WJ: Patient education for preventing diabetic foot ulceration A systematic review. Endocrinol Metab Clin North Am. 2002, 31 (3): 633-658. 10.1016/S0889-8529(02)00021-X.CrossRefPubMed Valk GD, Kriegsman DM, Assendelft WJ: Patient education for preventing diabetic foot ulceration A systematic review. Endocrinol Metab Clin North Am. 2002, 31 (3): 633-658. 10.1016/S0889-8529(02)00021-X.CrossRefPubMed
5.
go back to reference Mueller MJ, Zou D, Bohnert KL, Tuttle LJ, Sinacore DR: Plantar stresses on the neuropathic foot during barefoot walking. Phys Ther. 2008, 88 (11): 1375-1384. 10.2522/ptj.20080011.CrossRefPubMedPubMedCentral Mueller MJ, Zou D, Bohnert KL, Tuttle LJ, Sinacore DR: Plantar stresses on the neuropathic foot during barefoot walking. Phys Ther. 2008, 88 (11): 1375-1384. 10.2522/ptj.20080011.CrossRefPubMedPubMedCentral
6.
go back to reference Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, Bakker K, Cavanagh PR: Specific guidelines on footwear and offloading. Diabetes Metab Res Rev. 2008, 24 (Suppl 1): S192-S193.CrossRefPubMed Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, Bakker K, Cavanagh PR: Specific guidelines on footwear and offloading. Diabetes Metab Res Rev. 2008, 24 (Suppl 1): S192-S193.CrossRefPubMed
7.
go back to reference Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, Bakker K, Cavanagh PR: The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008, 24 (Suppl 1): S162-S180.CrossRefPubMed Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, Bakker K, Cavanagh PR: The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008, 24 (Suppl 1): S162-S180.CrossRefPubMed
8.
go back to reference Abboud RJ, Rowley DI, Newton RW: Lower limb muscle dysfunction may contribute to foot ulceration in diabetic patients. Clin Biomech (Bristol, Avon). 2000, 15 (1): 37-45. 10.1016/S0268-0033(99)00038-8.CrossRef Abboud RJ, Rowley DI, Newton RW: Lower limb muscle dysfunction may contribute to foot ulceration in diabetic patients. Clin Biomech (Bristol, Avon). 2000, 15 (1): 37-45. 10.1016/S0268-0033(99)00038-8.CrossRef
9.
go back to reference Kwon OY, Minor SD, Maluf KS, Mueller MJ: Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture. 2003, 18 (1): 105-113. 10.1016/S0966-6362(02)00166-2.CrossRefPubMed Kwon OY, Minor SD, Maluf KS, Mueller MJ: Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture. 2003, 18 (1): 105-113. 10.1016/S0966-6362(02)00166-2.CrossRefPubMed
10.
go back to reference Savelberg HH, Ilgin D, Angin S, Willems PJ, Schaper NC, Meijer K: Prolonged activity of knee extensors and dorsal flexors is associated with adaptations in gait in diabetes and diabetic polyneuropathy. Clin Biomech (Bristol, Avon). 2010, 25 (5): 468-475. 10.1016/j.clinbiomech.2010.02.005.CrossRef Savelberg HH, Ilgin D, Angin S, Willems PJ, Schaper NC, Meijer K: Prolonged activity of knee extensors and dorsal flexors is associated with adaptations in gait in diabetes and diabetic polyneuropathy. Clin Biomech (Bristol, Avon). 2010, 25 (5): 468-475. 10.1016/j.clinbiomech.2010.02.005.CrossRef
11.
go back to reference Savelberg HH, Schaper NC, Willems PJ, de Lange TL, Meijer K: Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy. BMC Musculoskelet Disord. 2009, 10: 16-10.1186/1471-2474-10-16.CrossRefPubMedPubMedCentral Savelberg HH, Schaper NC, Willems PJ, de Lange TL, Meijer K: Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy. BMC Musculoskelet Disord. 2009, 10: 16-10.1186/1471-2474-10-16.CrossRefPubMedPubMedCentral
12.
go back to reference Melai T, Schaper NC, Ijzerman TH, De Lange ALH, Willems PJB, Meijer K, Lieverse AG, Savelberg HHCM: Increased forefootloading is associated with an increased plantar flexion moment. Hum Mov Sci. 2013, 10.1016/j.humov.2013.05.001 Melai T, Schaper NC, Ijzerman TH, De Lange ALH, Willems PJB, Meijer K, Lieverse AG, Savelberg HHCM: Increased forefootloading is associated with an increased plantar flexion moment. Hum Mov Sci. 2013, 10.1016/j.humov.2013.05.001
13.
go back to reference IJzerman TH, Schaper NC, Melai T, Meijer K, Willems PJB, Savelberg HHCM: Lower extremity muscle strength is reduced in people with type 2 diabetes, with and without polyneuropathy, and is associated with impaired mobility and reduced quality of life. Diabetes Res Clin Pract. 2012, 95 (3): 345-351. 10.1016/j.diabres.2011.10.026.CrossRefPubMed IJzerman TH, Schaper NC, Melai T, Meijer K, Willems PJB, Savelberg HHCM: Lower extremity muscle strength is reduced in people with type 2 diabetes, with and without polyneuropathy, and is associated with impaired mobility and reduced quality of life. Diabetes Res Clin Pract. 2012, 95 (3): 345-351. 10.1016/j.diabres.2011.10.026.CrossRefPubMed
14.
go back to reference van Schie CH, Vermigli C, Carrington AL, Boulton A: Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men. Diabetes Care. 2004, 27 (7): 1668-1673. 10.2337/diacare.27.7.1668.CrossRefPubMed van Schie CH, Vermigli C, Carrington AL, Boulton A: Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men. Diabetes Care. 2004, 27 (7): 1668-1673. 10.2337/diacare.27.7.1668.CrossRefPubMed
15.
go back to reference Kouidi E, Albani M, Natsis K, Megalopoulos A, Gigis P, Guiba-Tziampiri O, Tourkantonis A, Deligiannis A: The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol Dial Transplant. 1998, 13 (3): 685-699. 10.1093/ndt/13.3.685.CrossRefPubMed Kouidi E, Albani M, Natsis K, Megalopoulos A, Gigis P, Guiba-Tziampiri O, Tourkantonis A, Deligiannis A: The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol Dial Transplant. 1998, 13 (3): 685-699. 10.1093/ndt/13.3.685.CrossRefPubMed
16.
go back to reference Chetlin RD, Gutmann L, Tarnopolsky M, Ullrich IH, Yeater RA: Resistance training effectiveness in patients with Charcot-Marie-Tooth disease: recommendations for exercise prescription. Arch Phys Med Rehabil. 2004, 85 (8): 1217-1223. 10.1016/j.apmr.2003.12.025.CrossRefPubMed Chetlin RD, Gutmann L, Tarnopolsky M, Ullrich IH, Yeater RA: Resistance training effectiveness in patients with Charcot-Marie-Tooth disease: recommendations for exercise prescription. Arch Phys Med Rehabil. 2004, 85 (8): 1217-1223. 10.1016/j.apmr.2003.12.025.CrossRefPubMed
17.
go back to reference Valk GD, de Sonnaville JJ, van Houtum WH, Heine RJ, van Eijk JT, Bouter LM, Bertelsmann FW: The assessment of diabetic polyneuropathy in daily clinical practice: reproducibility and validity of Semmes Weinstein monofilaments examination and clinical neurological examination. Muscle Nerve. 1997, 20 (1): 116-118. 10.1002/(SICI)1097-4598(199701)20:1<116::AID-MUS19>3.0.CO;2-2.CrossRefPubMed Valk GD, de Sonnaville JJ, van Houtum WH, Heine RJ, van Eijk JT, Bouter LM, Bertelsmann FW: The assessment of diabetic polyneuropathy in daily clinical practice: reproducibility and validity of Semmes Weinstein monofilaments examination and clinical neurological examination. Muscle Nerve. 1997, 20 (1): 116-118. 10.1002/(SICI)1097-4598(199701)20:1<116::AID-MUS19>3.0.CO;2-2.CrossRefPubMed
18.
go back to reference Melai T, Ijzerman TH, Schaper NC, de Lange TL, Willems PJ, Meijer K, Lieverse AG, Savelberg HH: Calculation of plantar pressure time integral, an alternative approach. Gait Posture. 2011, 34 (3): 379-383. 10.1016/j.gaitpost.2011.06.005.CrossRefPubMed Melai T, Ijzerman TH, Schaper NC, de Lange TL, Willems PJ, Meijer K, Lieverse AG, Savelberg HH: Calculation of plantar pressure time integral, an alternative approach. Gait Posture. 2011, 34 (3): 379-383. 10.1016/j.gaitpost.2011.06.005.CrossRefPubMed
19.
go back to reference Monteiro MA, Gabriel RE, Neves ECM, Sousa MF, Abrantes JM, Moreira MH: Exercise effects in plantar pressure of postmenopausal women. Menopause. 2010, 17 (5): 1017-1025. 10.1097/gme.0b013e3181ddf6ef.CrossRefPubMed Monteiro MA, Gabriel RE, Neves ECM, Sousa MF, Abrantes JM, Moreira MH: Exercise effects in plantar pressure of postmenopausal women. Menopause. 2010, 17 (5): 1017-1025. 10.1097/gme.0b013e3181ddf6ef.CrossRefPubMed
20.
go back to reference Delbridge L, Perry P, Marr S, Arnold N, Yue DK, Turtle JR, Reeve TS: Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabet Med. 1988, 5 (4): 333-337. 10.1111/j.1464-5491.1988.tb01000.x.CrossRefPubMed Delbridge L, Perry P, Marr S, Arnold N, Yue DK, Turtle JR, Reeve TS: Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabet Med. 1988, 5 (4): 333-337. 10.1111/j.1464-5491.1988.tb01000.x.CrossRefPubMed
21.
go back to reference van Deursen RW, Sanchez MM, Ulbrecht JS, Cavanagh PR: The role of muscle spindles in ankle movement perception in human subjects with diabetic neuropathy. Exp Brain Res. 1998, 120 (1): 1-8. 10.1007/s002210050371.CrossRefPubMed van Deursen RW, Sanchez MM, Ulbrecht JS, Cavanagh PR: The role of muscle spindles in ankle movement perception in human subjects with diabetic neuropathy. Exp Brain Res. 1998, 120 (1): 1-8. 10.1007/s002210050371.CrossRefPubMed
22.
go back to reference Courtemanche R, Teasdale N, Boucher P, Fleury M, Lajoie Y, Bard C: Gait problems in diabetic neuropathic patients. Arch Phys Med Rehabil. 1996, 77 (9): 849-855. 10.1016/S0003-9993(96)90269-5.CrossRefPubMed Courtemanche R, Teasdale N, Boucher P, Fleury M, Lajoie Y, Bard C: Gait problems in diabetic neuropathic patients. Arch Phys Med Rehabil. 1996, 77 (9): 849-855. 10.1016/S0003-9993(96)90269-5.CrossRefPubMed
23.
go back to reference Grimm A, Kastenbauer T, Sauseng S, Sokol G, Irsigler K: Progression and distribution of plantar pressure in Type 2 diabetic patients. Diabetes Nutr Metab. 2004, 17 (2): 108-113.PubMed Grimm A, Kastenbauer T, Sauseng S, Sokol G, Irsigler K: Progression and distribution of plantar pressure in Type 2 diabetic patients. Diabetes Nutr Metab. 2004, 17 (2): 108-113.PubMed
24.
go back to reference Veves A, Murray HJ, Young MJ, Boulton AJ: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992, 35 (7): 660-663. 10.1007/BF00400259.CrossRefPubMed Veves A, Murray HJ, Young MJ, Boulton AJ: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992, 35 (7): 660-663. 10.1007/BF00400259.CrossRefPubMed
25.
go back to reference Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ: Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care. 2003, 26 (4): 1069-1073. 10.2337/diacare.26.4.1069.CrossRefPubMed Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ: Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care. 2003, 26 (4): 1069-1073. 10.2337/diacare.26.4.1069.CrossRefPubMed
26.
go back to reference Miralles-Garcia JM, de Pablos-Velasco P, Cabrerizo L, Perez M, Lopez-Gomez V: Prevalence of distal diabetic polyneuropathy using quantitative sensory methods in a population with diabetes of more than 10 years’ disease duration. Endocrinol Nutr. 2010, 57 (9): 414-420. 10.1016/j.endonu.2010.05.006.CrossRefPubMed Miralles-Garcia JM, de Pablos-Velasco P, Cabrerizo L, Perez M, Lopez-Gomez V: Prevalence of distal diabetic polyneuropathy using quantitative sensory methods in a population with diabetes of more than 10 years’ disease duration. Endocrinol Nutr. 2010, 57 (9): 414-420. 10.1016/j.endonu.2010.05.006.CrossRefPubMed
27.
go back to reference Gill JM, Cooper AR: Physical activity and prevention of type 2 diabetes mellitus. Sports Med. 2008, 38 (10): 807-824. 10.2165/00007256-200838100-00002.CrossRefPubMed Gill JM, Cooper AR: Physical activity and prevention of type 2 diabetes mellitus. Sports Med. 2008, 38 (10): 807-824. 10.2165/00007256-200838100-00002.CrossRefPubMed
28.
go back to reference Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB: Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Int Med. 2001, 161 (12): 1542-1548. 10.1001/archinte.161.12.1542.CrossRef Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB: Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Int Med. 2001, 161 (12): 1542-1548. 10.1001/archinte.161.12.1542.CrossRef
29.
go back to reference Praet SF, van Rooij ES, Wijtvliet A, Boonman-de Winter LJ, Enneking T, Kuipers H, Stehouwer CD, van Loon LJ: Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial. Diabetologia. 2008, 51 (5): 736-746. 10.1007/s00125-008-0950-y.CrossRefPubMedPubMedCentral Praet SF, van Rooij ES, Wijtvliet A, Boonman-de Winter LJ, Enneking T, Kuipers H, Stehouwer CD, van Loon LJ: Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial. Diabetologia. 2008, 51 (5): 736-746. 10.1007/s00125-008-0950-y.CrossRefPubMedPubMedCentral
30.
go back to reference Thoolen B, de Ridder D, Bensing J, Gorter K, Rutten G: Who participates in diabetes self-management interventions?: Issues of recruitment and retainment. Diabetes Educ. 2007, 33 (3): 465-474. 10.1177/0145721707301491.CrossRefPubMed Thoolen B, de Ridder D, Bensing J, Gorter K, Rutten G: Who participates in diabetes self-management interventions?: Issues of recruitment and retainment. Diabetes Educ. 2007, 33 (3): 465-474. 10.1177/0145721707301491.CrossRefPubMed
Metagegevens
Titel
Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial
Auteurs
Tom Melai
Nicolaas C Schaper
T Herman IJzerman
Ton LH de Lange
Paul JB Willems
Valéria Lima Passos
Aloysius G Lieverse
Kenneth Meijer
Hans HCM Savelberg
Publicatiedatum
01-12-2013
Uitgeverij
BioMed Central
Gepubliceerd in
Journal of Foot and Ankle Research / Uitgave 1/2013
Elektronisch ISSN: 1757-1146
DOI
https://doi.org/10.1186/1757-1146-6-41