- Title
- The effectiveness of a stretching intervention in lowering plantar pressures related to reduced ankle range of motion in people with diabetes
- Creator
- Searle, Angela
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- This thesis provides a comprehensive investigation into the relationship between limited ankle dorsiflexion, ankle equinus, and elevated plantar pressures in people with diabetes. Elevated plantar pressures are of concern to people with diabetes as they have been clearly linked to the development and non-healing of foot ulcer. Ankle equinus is a foot complication associated with diabetes and has been proposed to contribute to the development of elevated plantar pressures. However, trials investigating this relationship have reported mixed results. Similarly, reported prevalence of ankle equinus in diabetes cohorts is variable in the literature, and is influenced by inconsistent definitions of equinus and differing techniques for measuring ankle joint dorsiflexion. Consequently, the true extent of the condition is not clear. In addition, current treatment options to correct limited ankle dorsiflexion, including surgery and night splints, are not easily administered or have poor adherence. Therefore, although ankle equinus represents a potentially widespread and modifiable risk factor for diabetic foot ulcer, identification and successful clinical management of this condition is challenging. Initially, by systematic review and meta-analysis of the available literature, we demonstrated that a majority of studies supported a relationship between limited ankle dorsiflexion and elevated plantar pressures in people with diabetes, particularly in those with a history of foot ulceration. Subsequently investigations were undertaken to develop methodologies for the research. This involved determining the reliability of the Lidcombe template and the Lunge test to measure non-weight bearing and weight bearing ankle dorsiflexion respectively in adults with diabetes. Intra- and inter-tester reliability for both methods was demonstrated to be excellent. Next our investigations into prevalence of non-weight bearing ankle equinus and any association with plantar pressures in a community-based group of 136 adults with diabetes, demonstrated a high prevalence of ankle equinus in this low risk cohort. Further, those people presenting with a non-weight bearing ankle equinus were more than twice as likely to present with ‘at risk’ in-shoe peak pressures as those without. Subsequently, a randomised controlled trial involving 68 community-based adults with either type 1 or type 2 diabetes and a non-weight bearing ankle equinus (dorsiflexion less than or equal to 5 degrees), was conducted to determine the effectiveness of a stretching intervention to increase ankle dorsiflexion and decrease plantar pressures. While current guidelines, including those from the American Diabetes Association, recommend stretching to maintain joint range of motion in people with diabetes, this trial demonstrated that calf muscle stretching as a stand-alone modality was not effective in increasing ankle dorsiflexion, or reducing plantar pressures, in this population. The investigations undertaken for this thesis served to highlight the inadequacies and errors present in non-weight bearing ankle dorsiflexion measurement, which unfortunately remains the most common method in use. Therefore, validation of a recently proposed weight bearing ankle equinus value, measured with the reliable Lunge test, was conducted in older adults with diabetes. The association found between a weight bearing equinus and elevated forefoot plantar pressures provides support for the proposed value. Further validation will be required in varied populations and in other conditions where an equinus is proposed to contribute to dysfunction.
- Subject
- equinus; diabetes; ankle; plantar pressure; RCT
- Identifier
- http://hdl.handle.net/1959.13/1401102
- Identifier
- uon:34871
- Rights
- Copyright 2019 Angela Searle
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 14 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 185 KB | Adobe Acrobat PDF | View Details Download |