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Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy

Lale Cerrahoglu Department of Physical Medicine and Rehabilitation, Celal Bayar University Faculty of Medicine, Manisa, Turkey. Dr. Ulusoy is now with the Department of Physical Medicine and Rehabilitation, Urla State Hospital, Izmir, Turkey.

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Umut Koşan Department of Physical Medicine and Rehabilitation, Burhaniye State Hospital-Balıkesir, Balıkesir, Turkey.

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Tuba Cerrahoglu Sirin Department of Neurology, Agri State Hospital, Agri, Turkey.

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Aslihan Ulusoy Department of Physical Medicine and Rehabilitation, Celal Bayar University Faculty of Medicine, Manisa, Turkey. Dr. Ulusoy is now with the Department of Physical Medicine and Rehabilitation, Urla State Hospital, Izmir, Turkey.

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Background: We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications.

Methods: Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program.

Results: In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05).

Conclusions: A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Corresponding author: Lale Cerrahoglu, Department of Physical Medicine and Rehabilitation, Celal Bayar University Faculty of Medicine, Uncubozkoy, Manisa, 45030 Turkey. (E-mail: lalecerrahoglu@yahoo.com)