Volume 4, Issue 3 (8-2022)                   IJMCL 2022, 4(3): 25-30 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Tedeschi R, Giorgi F. Manual Therapy in Diabetic Patients with Tibio-tarsal Dorsiflexion Deficit and Forefoot Overload: A Case Report. IJMCL. 2022; 4 (3) :25-30
URL: http://ijmcl.com/article-1-126-en.html
Msc Unibo, Bologna, Italy
Abstract:   (337 Views)
Introduction: Limitation of tibio-tarsal joint mobility in diabetic patients can occur within a few years of diagnosis, even in young patients. This joint movement deficit is believed to be due to stiffness in muscles, tendons, joint capsules, ligaments, and skin. With this in mind, the aim of this study is to design an experimental protocol of orthopedic manual therapy and therapeutic exercise in the future for subjects with diabetes, reduced joint mobility, and subsequent insufficient dorsal flexion of the tibio-ankle, and to test the reduced avampodalic pressure that correlates with an increased ulcerative risk.
Case presentation: A patient aged 64, male, overweight, family history of type II diabetes, self-employed, and diagnosed with diabetes type 2.
Results: The patient was evaluated with inertial motion sensors, a Baropodometric platform, a Lounge test, and MWM. Already after the first session, an improvement in plantar pressures was observed with a decrease both in the peaks from 413.6 Kpa to 99 Kpa in both feet and in the average plantar pressures from 129.8 Kpa to 54.5 Kpa for both feet with a decrease in plantar pressures at the forefoot from 43.7 % to 33.2 %. Tissue elasticity was assessed with the Lunge Test, and increased from 8 cm to 9.5 cm.
Conclusion: The results suggest that the role of manual treatment combined with an exercise program could increase tarsal dorsiflexion and consequently decrease plantar pressures.
Full-Text [PDF 1561 kb]   (22 Downloads)    
Type of Study: Case Report | Subject: 2-2. Rehabilitation
Received: 2022/04/18 | Accepted: 2022/07/22 | Published: 2022/08/25

1. Anon. n.d.-a. "Standard Italiani 2.0 AMD-SID standard italiani per la cura del diabete mellito 2014 - Il Diabete Online." Retrieved May 8, 2022 (https://www.ildiabeteonline.it/standard-italiani-2-0-amd-sid-standard-italiani-per-la-cura-del-diabete-mellito-2014/).
2. Anon. n.d.-b. "Wiva - Inertial System for Performance Analysis." Retrieved May 8, 2022 (http://www.e-wiva.com/).
3. Apelqvist, J., K. Bakker, W. H. van Houtum, N. C. Schaper, and International Working Group on the Diabetic Foot (IWGDF) Editorial Board. 2008. "Practical Guidelines on the Management and Prevention of the Diabetic Foot: Based upon the International Consensus on the Diabetic Foot (2007) Prepared by the International Working Group on the Diabetic Foot." Diabetes/Metabolism Research and Reviews 24 Suppl 1: S181-187. doi: 10.1002/dmrr.848. [DOI:10.1002/dmrr.848]
4. Bennell, Kim L., Richard C. Talbot, Henry Wajswelner, Wassana Techovanich, David H. Kelly, and Andrew J. Hall. 1998. "Intra-Rater and Inter-Rater Reliability of a Weight-Bearing Lunge Measure of Ankle Dorsiflexion." The Australian Journal of Physiotherapy 44(3):175-80. doi: 10.1016/s0004-9514(14)60377-9. [DOI:10.1016/S0004-9514(14)60377-9]
5. Boulton, Andrew J. M., David G. Armstrong, Stephen F. Albert, Robert G. Frykberg, Richard Hellman, M. Sue Kirkman, Lawrence A. Lavery, Joseph W. LeMaster, Joseph L. Mills, Michael J. Mueller, Peter Sheehan, and Dane K. Wukich. 2008. "Comprehensive Foot Examination and Risk Assessment." Diabetes Care 31(8):1679-85. doi: 10.2337/dc08-9021. [DOI:10.2337/dc08-9021]
6. Cejudo, Antonio, Pilar Sainz de Baranda, Francisco Ayala, and Fernando Santonja. 2014. "A Simplified Version of the Weight-Bearing Ankle Lunge Test: Description and Test-Retest Reliability." Manual Therapy 19(4):355-59. doi: 10.1016/j.math.2014.03.008. [DOI:10.1016/j.math.2014.03.008]
7. Collins, Natalie, Pamela Teys, and Bill Vicenzino. 2004. "The Initial Effects of a Mulligan's Mobilization with Movement Technique on Dorsiflexion and Pain in Subacute Ankle Sprains." Manual Therapy 9(2):77-82. doi: 10.1016/S1356-689X(03)00101-2. [DOI:10.1016/S1356-689X(03)00101-2]
8. Fernando, D. J., E. A. Masson, A. Veves, and A. J. Boulton. 1991. "Relationship of Limited Joint Mobility to Abnormal Foot Pressures and Diabetic Foot Ulceration." Diabetes Care 14(1):8-11. doi: 10.2337/diacare.14.1.8. [DOI:10.2337/diacare.14.1.8]
9. Francia, Piergiorgio, Roberto Anichini, Giuseppe Seghieri, Alessandra De Bellis, and Massimo Gulisano. 2018. "History, Prevalence and Assessment of Limited Joint Mobility, from Stiff Hand Syndrome to Diabetic Foot Ulcer Prevention: A Narrative Review of the Literature." Current Diabetes Reviews 14(5):411-26. doi: 10.2174/1573399813666170816142731. [DOI:10.2174/1573399813666170816142731]
10. Gabbe, Belinda J., Caroline F. Finch, Henry Wajswelner, and Kim L. Bennell. 2004. "Predictors of Lower Extremity Injuries at the Community Level of Australian Football." Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine 14(2):56-63. doi: 10.1097/00042752-200403000-00002. [DOI:10.1097/00042752-200403000-00002]
11. Giacomozzi, Claudia, Antonella Caselli, Velio Macellari, Laura Giurato, Lina Lardieri, and Luigi Uccioli. 2002. "Walking Strategy in Diabetic Patients with Peripheral Neuropathy." Diabetes Care 25(8):1451-57. doi: 10.2337/diacare.25.8.1451. [DOI:10.2337/diacare.25.8.1451]
12. Hidalgo, Benjamin, Toby Hall, Mathilde Berwart, Elinor Biernaux, and Christine Detrembleur. 2018. "The Immediate Effects of Two Manual Therapy Techniques on Ankle Musculoarticular Stiffness and Dorsiflexion Range of Motion in People with Chronic Ankle Rigidity: A Randomized Clinical Trial." Journal of Back and Musculoskeletal Rehabilitation 31(3):515-24. doi: 10.3233/BMR-170963. [DOI:10.3233/BMR-170963]
13. Lepesis, Vasileios, Jonathan Marsden, Joanne Paton, Alec Rickard, and Jos M. Latour. 2022. "Experiences of Foot and Ankle Mobilisations Combined with Home Stretches in People with Diabetes: A Qualitative Study Embedded in a Proof-of-Concept Randomised Controlled Trial." Journal of Foot and Ankle Research 15(1):7. doi: 10.1186/s13047-022-00512-z. [DOI:10.1186/s13047-022-00512-z]
14. Marrón-Gómez, David, Ángel L. Rodríguez-Fernández, and José A. Martín-Urrialde. 2015. "The Effect of Two Mobilization Techniques on Dorsiflexion in People with Chronic Ankle Instability." Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine 16(1):10-15. doi: 10.1016/j.ptsp.2014.02.001. [DOI:10.1016/j.ptsp.2014.02.001]
15. Mason-Mackay, A. R., C. Whatman, and D. Reid. 2017. "The Effect of Reduced Ankle Dorsiflexion on Lower Extremity Mechanics during Landing: A Systematic Review." Journal of Science and Medicine in Sport 20(5):451-58. doi: 10.1016/j.jsams.2015.06.006. [DOI:10.1016/j.jsams.2015.06.006]
16. Mueller, Michael J., Jay E. Diamond, Anthony Delitto, and David R. Sinacore. 1989. "Insensitivity, Limited Joint Mobility, and Plantar Ulcers in Patients with Diabetes Mellitus." Physical Therapy 69(6):453-59. doi: 10.1093/ptj/69.6.453. [DOI:10.1093/ptj/69.6.453]
17. Pope, Rodney, Rob Herbert, and John Kirwan. 1998. "Effects of Ankle Dorsiflexion Range and Pre-Exercise Calf Muscle Stretching on Injury Risk in Army Recruits." The Australian Journal of Physiotherapy 44(3):165-72. doi: 10.1016/s0004-9514(14)60376-7. [DOI:10.1016/S0004-9514(14)60376-7]
18. Powden, Cameron J., Johanna M. Hoch, and Matthew C. Hoch. 2015. "Reliability and Minimal Detectable Change of the Weight-Bearing Lunge Test: A Systematic Review." Manual Therapy 20(4):524-32. doi: 10.1016/j.math.2015.01.004. [DOI:10.1016/j.math.2015.01.004]
19. Rao, Smita, Charles L. Saltzman, and H. John Yack. 2010. "Relationships between Segmental Foot Mobility and Plantar Loading in Individuals with and without Diabetes and Neuropathy." Gait & Posture 31(2):251-55. doi: 10.1016/j.gaitpost.2009.10.016. [DOI:10.1016/j.gaitpost.2009.10.016]
20. Sacco, I. C. N., A. N. Hamamoto, A. A. Gomes, A. N. Onodera, R. P. Hirata, and E. M. Hennig. 2009. "Role of Ankle Mobility in Foot Rollover during Gait in Individuals with Diabetic Neuropathy." Clinical Biomechanics (Bristol, Avon) 24(8):687-92. doi: 10.1016/j.clinbiomech.2009.05.003. [DOI:10.1016/j.clinbiomech.2009.05.003]
21. Sawacha, Zimi, Guarneri Gabriella, Giuseppe Cristoferi, Annamaria Guiotto, Angelo Avogaro, and Claudio Cobelli. 2009. "Diabetic Gait and Posture Abnormalities: A Biomechanical Investigation through Three-Dimensional Gait Analysis." Clinical Biomechanics (Bristol, Avon) 24(9):722-28. doi: 10.1016/j.clinbiomech.2009.07.007. [DOI:10.1016/j.clinbiomech.2009.07.007]
22. Searle, A., M. J. Spink, A. Ho, and V. H. Chuter. 2017. "Association between Ankle Equinus and Plantar Pressures in People with Diabetes. A Systematic Review and Meta-Analysis." Clinical Biomechanics (Bristol, Avon) 43:8-14. doi: 10.1016/j.clinbiomech.2017.01.021. [DOI:10.1016/j.clinbiomech.2017.01.021]
23. Williams, Cylie M., Antoni J. Caserta, and Terry P. Haines. 2013. "The TiltMeter App Is a Novel and Accurate Measurement Tool for the Weight Bearing Lunge Test." Journal of Science and Medicine in Sport 16(5):392-95. doi: 10.1016/j.jsams.2013.02.001. [DOI:10.1016/j.jsams.2013.02.001]
24. Yumpu.com. n.d. "valutazione delle distribuzioni delle pressioni plantari in soggetti con ..." yumpu.com. Retrieved May 8, 2022 (https://www.yumpu.com/it/document/view/14922720/valutazione-delle-distribuzioni-delle-pressioni-plantari-in-soggetti-con-).
25. Zimny, Stefan, Helmut Schatz, and Martin Pfohl. 2004. "The Role of Limited Joint Mobility in Diabetic Patients with an At-Risk Foot." Diabetes Care 27(4):942-46. doi: 10.2337/diacare.27.4.942. [DOI:10.2337/diacare.27.4.942]
26. Zordão, Catarina Clapis, Emilson Sodré Mendonça Junior, Paola Marini Valério, Carla Silva Perez, Ana Paula Ferro, and Elaine Caldeira de Oliveira Guirro. 2021. "Immediate Effect of Manual Therapy on Tibiotarsal Joint Mobility and Static Balance in Individuals with Diabetes." Journal of Chiropractic Medicine 20(3):128-37. doi: 10.1016/j.jcm.2021.10.001. [DOI:10.1016/j.jcm.2021.10.001]

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and Permissions
Creative Commons License This work is licensed under Attribution 4.0 International (CC BY 4.0).

© 2022 CC BY 4.0 | International Journal of Motor Control and Learning

Designed & Developed by : Yektaweb