Effect of Subtalar and Talocrural Joint Mobilization on Foot Ranges and Posture in Diabetic Patients
Condition: Diabetic Foot
MeSH terms: Diabetic Foot
Study type: Interventional

Summary: 
      The aim of this research is to determine the Effects of mobilizations on foot ranges and
      posture in people with Type 2 Diabetes Mellitus. Randomized controlled trials will be done at
      Dr. Akbar Niazi Teaching Hospital ANTH, Bhara kahu Islamabad. The sample size will be 42. The
      subjects were divided in two groups, with 21 subjects in Group A and 21 in Group B. Study
      duration is 6 months. Sampling technique applied was Non probability Convenience Sampling
      technique. Both males and females of aged 45-65 having Type 2 Diabetes were included. Tools
      used in the study are Spirit Level Mobile Application (android)-Smartphone Goniometer, Foot
      Posture Index-6 and DN4-Douleur Neuropathique 4 Questionnaire.
    

Detailed description: 
      Diabetes mellitus is a heterogeneous metabolic disease due to insulin disturbance affecting
      around 422 Million people worldwide according to the WHO it is characterized by hyperglycemia
      and ischemia, as a result of defects in insulin secretion. Type 2 diabetes mellitus (T2DM)
      ranks highly on the international health agenda as a global pandemic and as a threat to human
      health and global economies. The number of people with T2DM worldwide has more than doubled
      during the past 20 years. Lower extremity musculoskeletal complications are frequently
      observed in people with diabetes mellitus (DM) and peripheral neuropathy (PN) and include
      limited joint mobility, impaired strength, atrophy causing increased stiffness of articular
      capsule, ligaments and tendons. Ankle planter flexion and dorsiﬂexion was found to be
      decreased preventing the ankle from reaching its closed-pack position by holding the ankle in
      a hyper supinated position. People with DMPN have a dorsi flexed foot and ankle position
      resulting in slow gait with prolonged disease secondary to the peripheral effect of the
      disease on other body systems.

      According to Abate and colleagues there is a 24% reduction in ankle plantar-flexion range of
      motion in people with DM. Manual mobilizations have proved to decrease the stiffness at ankle
      joint improving the ranges in previous studies Previous literature have shown that
      Interventions to address foot and ankle plantar-flexion mobilizations could improve its
      function by increasing flexibility reduce the risk of plantar ulceration. Distraction of the
      distal tibiofibular joint has been thought to increase space and decrease impingement in the
      talocural joint to allow full ankle dorsiflexion.
    

Intervention name(s): subtalar and talo-crural mobilization; International Working Group of the Diabetic Foot care guidelines
Intervention type(s): Other; Other
Intervention description(s): Traction, Antero Posterior (AP) and Postero Anterior (PA) Maitland Grade III oscillatory mobilizations of 2Hz with 120 oscilations per minute, 3 sets for 5 minutes with 1 min of rest between sets at subtalar and talocrural joint would be performed. The mobilization would be large amplitude rhythmic oscillations from the joint mid into end-range muscle spasm/stiffness (translation taken to tissue resistance). Duration will be 20 minutes with 2 sessions per week, total 12 sessions would be performed on each patient in the total period of 6 weeks.
Patients will be guided to follow self foot care examination given by IWGDF Guidelines.; Patients will continue their usual activities according to International Working Group on Diabetic Foot (IWGDF) guidelines including the measures of inspecting the feet, self- examination for callus, pre-ulcerative signs or deformity. They will be restrict barefoot walking in-door and outdoors. To wash their feet daily with careful drying, to use emollients to prevent dryness and cut their nails straight across. Monitor the foot skin temperature for inflammation, wear orthotic insoles for preventing abundant callus.
Patients will perform active ROM exercises 5 times per week for duration of 30 minutes for 6 weeks:Ankle pumps, Supination and Pronation, Drawing score from 0 to 9, Leg Flexion and Extension
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Foot Mobilizations; ankle range of motion; Diabetic Neuropathy; foot posture Index