Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
J Foot Ankle Res. 2013 Oct 18;6(1):41. doi: 10.1186/1757-1146-6-41.
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.
This study was embedded in a clinical trial with trial number NCT00759265.
较高的足底压力在糖尿病多发性神经病患者足底溃疡的发展中起着重要作用，早期研究表明，前脚的压力较高可能与小腿肌肉力量下降有关。因此，在这项随机对照试验中，我们评估了下肢力量训练是否可以降低糖尿病多发性神经病患者的足底压力。
本研究嵌入在一项非盲随机对照试验中。参与者患有糖尿病和多发性神经病，并被随机分配到干预组（n=48），接受 24 周的力量训练，或对照组（n=46），不接受干预。在 0、12、24 和 52 周时，两组均测量足底压力。应用随机截距模型评估干预对峰值压力和压力-时间积分、中心压力位移以及前足与后足压力-时间积分比的影响。
力量训练并未影响足底压力模式。在干预组和对照组中，前足的峰值压力和压力-时间积分在 52 周内分别增加了 55.7kPa（95%CI：14.7，96.8）和 2.0kPa.s（95%CI：0.9，3.2）。两组均有大量的脱落者，主要是由于健康状况恶化和下肢残疾。
患有糖尿病多发性神经病的患者，前足的足底压力随着时间的推移逐渐增加，但在本研究中，力量训练并没有影响到这些压力。未来的干预研究应该考虑到足底压力的这种增加，并开发替代干预措施来减少这些患者下肢的进行性问题。
本研究嵌入在一项临床试验中，试验编号为 NCT00759265。
