###### Abstract  
Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot-ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot-ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 \(\pm\) 6.4 years, 23.5 \(\pm\) 4.8 kg/m\({}^{2}\), males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 \(\pm\) 9.4 years, 22.9 \(\pm\) 3.6 kg/m\({}^{2}\), males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (\(p\) = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect \(p\) = 0.020, mean difference = \(-\)64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (\(p\) = 0.007) and for the knee and hip at push off over 8 and 16 weeks (\(p\) < 0.001 and \(p\) = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot-ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot-ankle kinematics and kinetics. physical therapy modalities; self-rehabilitation; foot; diabetic neuropathy; diabetic foot; clinical trial 202313142313142313  
culoskeletal and sensorial deficits [12; 13]. A structured therapeutic exercise targeting the lower extremities may be a strategy for treatment of DPN-related complications [14; 15; 16; 17; 18; 19]. Supervised foot-related exercise therapy (individual or group) is well-documented in the literature [14; 16; 17; 18; 20; 21; 22; 23; 24; 25; 26; 27] and the International Guidelines of Prevention of Diabetic Foot includes this approach as part of the self-management plan to modify risk factors in people with DPN [28]. The main effects of supervised foot-related exercises are improving the plantar pressure distribution during gait [14; 16; 22; 27], foot-ankle range of motion (ROM) [16; 20; 25], foot-ankle strength [17; 18], DPN symptoms and sensitivity [16; 18], and walking speed [23; 25; 29]. All beneficial changes that were report in the literature are not retained at follow-up [14]; therefore, health professionals are encouraged to incorporate information/communication-based technologies that enhance home-based exercise as an alternative treatment as they can improve patient adherence to treatment and even reduce waiting time at rehabilitation services. However, the extent to which this approach fulfills the expectations of people with DPN and helps them to exercise at home is still to be determined. A few home-based exercise clinical trials and/or controlled studies have shown positive results for people with DPN, such as reduced DPN symptoms [21], foot pain [15], and peak pressure during gait [24]. However, its effects on the foot-ankle ROM and strength, gait biomechanics, and functionality in people with DPN is still unclear. A feasibility study from the current clinical trial showed that home-based exercises were adhered to (77.7%) and positive changes in clinical and biomechanical measures were seen, such as improved DPN severity and ROM of the midfoot during gait [30].