Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT.

Abstract

Introduction People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs. Design and methods Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint, dynamic plantar pressure and balance. Results No significant differences in dynamic ankle dorsiflexion were found between both groups. A statistically significant difference was observed in ankle dorsiflexion range in both feet across time between groups (Left 1.52cm and 2.9cms, Right 1.62cm and 2.7cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between both groups, a significant increase in functional reach was observed (T1 = 3.13cm p < 0.05 and T2 = 3.9cm p < 0.01). Between group differences were seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion (4.9°, p < 0.01) at T2 follow up. No significant between group differences were found for peak plantar pressure or postural sway. Intervention adherence was high (80%). Conclusions Combining ankle and 1st MTP joint mobilisations with home stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk. Trial registration https://classic.clinicaltrials.gov/ct2/show/NCT03195855