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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

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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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

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Abstract

Background

Methods

Results

Conclusions

Trial registration

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