School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK.
School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
J Foot Ankle Res. 2023 Dec 6;16(1):88. doi: 10.1186/s13047-023-00690-4.
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-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs.
Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1 MTP joint mobilisations (n = 31) and home-based 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 dorsiflexion ROM, dynamic plantar pressure and balance.
At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%).
Combining ankle and 1 MTP joint mobilisations with home-based 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.
gov/ct2/show/NCT03195855 .
患有糖尿病周围神经病变（DPN）和有限关节活动度综合征（LJMS）的人可能会出现前足峰值足底压力（PPP）增加，这是溃疡的已知危险因素。本研究旨在探讨DPN 患者的踝关节和第一跖趾（MTP）关节松动术以及家庭伸展运动是否能改善关节活动范围（ROM）并降低前足 PPP。
61 名患有 DPN（IWGDF 风险 2）的患者被随机分配到为期 6 周的踝关节和 1 MTP 关节松动术（n=31）和家庭伸展运动或仅标准护理组（n=30）。在基线（T0）；6 周干预后（T1）和 3 个月随访（T2），一位盲法评估者使用 3D（Codamotion）运动分析和负重弓步测试记录动态踝关节背屈范围，静态第一 MTP 关节背屈 ROM、动态足底压力和平衡。
在 T1 和 T2 时，两组在站立相的踝关节背屈、足底压力和平衡方面均无差异。与对照组相比，干预组在 6 周（T1）和 18 周（T2）时静态踝关节背屈范围均有统计学显著增加（左侧 1.52cm 和 2.9cms，右侧 1.62cm 和 2.7cm）p<0.01）。组间差异也见于左侧大脚趾背屈（2.75°，p<0.05）在 T1 和右侧大脚趾背屈 ROM（4.9°，p<0.01）在 T2 随访时。此外，功能性伸展在干预组中显著增加（T1=3.13cm，p<0.05；T2=3.9cm，p<0.01）。干预依从性高（80%）。
在患有 DPN 的患者中，将踝关节和 1 MTP 关节松动术与家庭伸展运动相结合，在 6 周的方案中是有效的，可以增加静态范围测量值。这种干预措施可能有助于改善糖尿病和神经病患者的踝关节、大脚趾关节活动度和前后稳定性限制，但不能降低 PPP 或足部溃疡风险。
https://classic.clinicaltrials.gov/ct2/show/NCT03195855。
gov/ct2/show/NCT03195855。
