Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSARTOR, Cristina D.
dc.contributor.authorHASUE, Renata H.
dc.contributor.authorCACCIARI, Licia P.
dc.contributor.authorBUTUGAN, Marco K.
dc.contributor.authorWATARI, Ricky
dc.contributor.authorPASSARO, Anice C.
dc.contributor.authorGIACOMOZZI, Claudia
dc.contributor.authorSACCO, Isabel C. N.
dc.date.accessioned2014-09-30T14:40:34Z
dc.date.available2014-09-30T14:40:34Z
dc.date.issued2014
dc.description.abstractBackground: Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. AIM: To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. Methods: A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Results: Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Conclusions: Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy.
dc.description.indexMEDLINE
dc.identifier.citationBMC MUSCULOSKELETAL DISORDERS, v.15, article ID 137, 13p, 2014
dc.identifier.doi10.1186/1471-2474-15-137
dc.identifier.issn1471-2474
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/7483
dc.language.isoeng
dc.publisherBIOMED CENTRAL LTD
dc.relation.ispartofBMC Musculoskeletal Disorders
dc.rightsopenAccess
dc.rights.holderCopyright BIOMED CENTRAL LTD
dc.subjectDiabetic neuropathies
dc.subjectRehabilitation
dc.subjectExercise therapy
dc.subjectWalking
dc.subjectRandomized controlled trial
dc.subjectFoot
dc.subjectAnkle
dc.subjectMusculoskeletal manipulation
dc.subject.otherperipheral neuropathy
dc.subject.otherplantar pressures
dc.subject.othermuscle weakness
dc.subject.othermissing data
dc.subject.otherhigh-risk
dc.subject.othergait
dc.subject.otherulceration
dc.subject.otherulcers
dc.subject.otherindividuals
dc.subject.othermobility
dc.subject.wosOrthopedics
dc.subject.wosRheumatology
dc.titleEffects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryItália
hcfmusp.affiliation.countryisoit
hcfmusp.author.externalGIACOMOZZI, Claudia:Italian Natl Inst Hlth, Dept Technol & Hlth, Rome, Italy
hcfmusp.citation.scopus91
hcfmusp.contributor.author-fmusphcCRISTINA DALLEMOLE SARTOR
hcfmusp.contributor.author-fmusphcRENATA HYDEE HASUE
hcfmusp.contributor.author-fmusphcLICIA PAZZOTO CACCIARI
hcfmusp.contributor.author-fmusphcMARCO KENJI BUTUGAN
hcfmusp.contributor.author-fmusphcRICKY WATARI
hcfmusp.contributor.author-fmusphcANICE DE CAMPOS PASSARO
hcfmusp.contributor.author-fmusphcISABEL DE CAMARGO NEVES SACCO
hcfmusp.description.articlenumber137
hcfmusp.description.volume15
hcfmusp.origemWOS
hcfmusp.origem.pubmed24767584
hcfmusp.origem.scopus2-s2.0-84901501564
hcfmusp.origem.wosWOS:000337324800001
hcfmusp.publisher.cityLONDON
hcfmusp.publisher.countryENGLAND
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