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01-12-2013 | Research | Uitgave 1/2013 Open Access

Journal of Foot and Ankle Research 1/2013

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

Journal of Foot and Ankle Research > Uitgave 1/2013
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
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-6-41) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors were involved in the conception and design of this study. TM and THIJ carried out data acquisition and study site coordination. PJBW lead the data acquisition and set up analysis and data processing. VLP lead the statistical analysis and TM, NCS, HHCMS, TLHdL, carried out or participated in analysis and interpretation of the data. TM wrote the first draft of the manuscript, with the help of NCS, HHCMS and TLHdL. All authors read and approved the final version of the manuscript.



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.


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.


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.


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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