The Effects of Range-of-Motion Therapy on the Plantar Pressures of Patients with Diabetes Mellitus

Abstract

A randomized controlled study of 19 patients with diabetes mellitus (10 men, 9 women) was undertaken to determine the effects of home exercise therapy on joint mobility and plantar pressures. Of the 19 subjects, 9 subjects performed unsupervised active and passive range-of-motion exercises of the joints in their feet. Each subject was evaluated for joint stiffness and peak plantar pressures at the beginning and conclusion of the study. After only 1 month of therapy, a statistically significant average decrease of 4.2% in peak plantar pressures was noted in the subjects performing the range-of-motion exercises. In the control group, an average increase of 4.4% in peak plantar pressures was noted. Although the joint mobility data revealed no statistically significant differences between the groups, there was a trend for a decrease in joint stiffness in the treatment group. The results of this study demonstrate that an unsupervised range-of-motion exercise program can reduce peak plantar pressures in the diabetic foot. Given that high plantar pressures have been linked to diabetic neuropathic ulceration, it may be possible to reduce the risk of such ulceration with this therapy.

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

“…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.…”

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“…Some studies have demonstrated promising biomechanical results by incorporating foot-specific exercises in people with DMPN 25 , 64 - 66 . Common elements of foot-specific interventions include toe/forefoot ROM, ankle and subtalar ROM, and intrinsic and extrinsic foot muscle strengthening.…”

Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?

“…Physical therapy and rehabilitation in diabetic foot of the alphabet with their feet and also practiced passive and active dorsiflexion of the ankles and metatarsophalangeal joints, plantar flexion, active subtalar joint pronation and supination, stretching of the gastrocnemius and soleus muscles. The authors reported that these exercises resulted in a reduction in the joint limitation and foot plantar pressure during walking [60] . In patients with a diabetic foot ulcer, Flahr et al [59] assessed the effects of 10-repetition foot exercises, consisting of the active inversion, eversion, dorsiflexion and plantar flexion of the feet and ankles, practiced twice daily.…”

“…In a study by Goldsmith et al [60] investigating the efficacy of range-of-motion exercises in diabetic foot patients, they asked the patients to draw letters Turan Y et al . Physical therapy and rehabilitation in diabetic foot of the alphabet with their feet and also practiced passive and active dorsiflexion of the ankles and metatarsophalangeal joints, plantar flexion, active subtalar joint pronation and supination, stretching of the gastrocnemius and soleus muscles.…”

“…Range of joint motion, stretching exercises, Buerger-Allen exercise, and proprioception and balance exercises may be helpful in patients with, or predisposition to, a diabetic foot ulcer [58][59][60] . Exercises involving range of joint motion or stretching in all directions may increase the blood flow to the feet.…”