title: Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  This study was embedded in a clinical trial with trial number NCT00759265.
authors.affiliation: Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands. Hans.Savelberg@MaastrichtUniversity.nl.
authors.forename: Tom
authors.initials: T
authors.lastname: Melai
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.forename: T Herman
authors.initials: TH
authors.lastname: Ijzerman
authors.forename: Ton Lh
authors.initials: TL
authors.lastname: de Lange
authors.forename: Paul Jb
authors.initials: PJ
authors.lastname: Willems
authors.forename: Valéria
authors.initials: V
authors.lastname: Lima Passos
authors.forename: Aloysius G
authors.initials: AG
authors.lastname: Lieverse
authors.forename: Kenneth
authors.initials: K
authors.lastname: Meijer
authors.forename: Hans Hcm
authors.initials: HH
authors.lastname: Savelberg