Motor Learning of a Gait Pattern to Reduce Forefoot Plantar Pressures in Individuals with Diabetic Peripheral Neuropathy

York, Robyn; Perell-Gerson, Karen L.; Barr, Michele; Durham, Jayson; Roper, Janice

doi:10.1016/j.pmrj.2009.03.001

Cited by 36 publications

(54 citation statements)

References 17 publications

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“…Previous studies do not describe the foot rollover changes after such a specific set of exercises for foot and ankle [24-27]. Usually, attention is mostly given to PP and PTI reduction as a target to reduce the risk of ulceration, but these variables should be analyzed together with several other risk factors [4,5,36].…”

Section: Discussionmentioning

confidence: 99%

“…Few authors have described the subtle, positive effects of foot and ankle exercises in this population, although some studies were not randomized controlled trials [24,25], and others reported on quite short interventions and follow-up periods [26,27]. Therefore, there are still not enough data for conclusions to be arrived at regarding the effectiveness of such interventions.…”

Section: Introductionmentioning

confidence: 99%

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

Sartor

Hasue

Cacciari

et al. 2014

BMC Musculoskelet Disord

118

185

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BackgroundFoot 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.MethodsA 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.ResultsEven 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).ConclusionsIntervention 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.Trial registrationClinicalTrials.gov Identifier: NCT01207284, registered in 20th September 2010.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sartor

Hasue

Cacciari

et al. 2014

BMC Musculoskelet Disord

118

185

View full text Add to dashboard Cite

show abstract

“…Interventions that focused on foot and ankle recovery and their impact on gait have presented partially good outcomes [60-62]. Some improvement in balance and confidence in a population with DPN was shown by Richardson et al [60].…”

Section: Introductionmentioning

confidence: 99%

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial

Sartor

Watari

Pássaro

et al. 2012

BMC Musculoskelet Disord

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BackgroundPolyneuropathy is a complication of diabetes mellitus that has been very challenging for clinicians. It results in high public health costs and has a huge impact on patients' quality of life. Preventive interventions are still the most important approach to avoid plantar ulceration and amputation, which is the most devastating endpoint of the disease. Some therapeutic interventions improve gait quality, confidence, and quality of life; however, there is no evidence yet of an effective physical therapy treatment for recovering musculoskeletal function and foot rollover during gait that could potentially redistribute plantar pressure and reduce the risk of ulcer formation.Methods/DesignA randomised, controlled trial, with blind assessment, was designed to study the effect of a physiotherapy intervention on foot rollover during gait, range of motion, muscle strength and function of the foot and ankle, and balance confidence. The main outcome is plantar pressure during foot rollover, and the secondary outcomes are kinetic and kinematic parameters of gait, neuropathy signs and symptoms, foot and ankle range of motion and function, muscle strength, and balance confidence. The intervention is carried out for 12 weeks, twice a week, for 40-60 min each session. The follow-up period is 24 weeks from the baseline condition.DiscussionHerein, we present a more comprehensive and specific physiotherapy approach for foot and ankle function, by choosing simple tasks, focusing on recovering range of motion, strength, and functionality of the joints most impaired by diabetic polyneuropathy. In addition, this intervention aims to transfer these peripheral gains to the functional and more complex task of foot rollover during gait, in order to reduce risk of ulceration. If it shows any benefit, this protocol can be used in clinical practice and can be indicated as complementary treatment for this disease.Trial RegistrationClinicalTrials.gov Identifier: NCT01207284

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“…Parmi elles, des capteurs de pression plantaire [13][14][15][16][17][18][19][20][21][22][23][24], les accéléromètres [25][26][27][28][29][30][31][32][33][34][35][36][37], les goniométres [38][39], les systèmes optoélectro-niques [40][41]. Cependant, ces technologies sont limitées au laboratoire de recherche et sont peu adaptées à une utilisation « grand public ».…”

Section: Introductionunclassified

Techniques d’évaluation à domicile de la qualité de l’équilibre et de la force de préhension chez la personne âgée en perte d’autonomie

Michel-Pellegrino

Hewson

et al. 2009

IRBM

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Motor Learning of a Gait Pattern to Reduce Forefoot Plantar Pressures in Individuals with Diabetic Peripheral Neuropathy

Abstract: Individuals with diabetic peripheral neuropathy were unable to use a "new" strategy gait pattern to reduce peak plantar pressures long term (1 week). The use of visual feedback following the trial did not assist in the learning of a new walking pattern.

Cited by 36 publications

References 17 publications

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

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

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial

Techniques d’évaluation à domicile de la qualité de l’équilibre et de la force de préhension chez la personne âgée en perte d’autonomie

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