Effects of Foot Muscle Strengthening in Daily Activity in Diabetic Neuropathic Patients

A randomized controlled trial will be performed with 77 patients with diabetic neuropathy. The participants will be randomly assigned into either a control group (recommended foot care by international consensus with no exercises) or an intervention group which will receive 12-week physical therapy exercises, twice a week, under the supervision of a physiotherapist, and twice a week being remotely supervised by a software at home. Every exercise has its own progression depending on the subjects' execution, increasing in intensity and difficulty.

The subjects will be evaluated in 5 different moments (Baseline, 6 weeks, 12 weeks, 24 weeks and 1 year follow-up)

The hypothesis of this study is that the intervention group will increase daily activity levels, increase self-selected and rapid walking speed, reduce the incidence of plantar ulcers, increase foot health and functionality, improve symptoms, increase tactile and vibration sensitivity, increased passive range of motion, improved quality of life, increased isometric strength of the feet and production of beneficial biomechanical changes during walking compared to the control group after 12 weeks of intervention and follow-up year.

Inclusion criteria

• Diabetes mellitus type 1 or 2
• Moderate or severe polyneuropathy confirmed with the fuzzy software
• Ability to walk independently in the laboratory
• Accessibility to electronic devices
• Loss of at least 4 degrees of ankle range of motion
• Loss of at least 1 degree of force in the clinical scale of the plantar interosseous or lumbrical muscles

Exclusion criteria

• Ulceration not healed for at least 6 months
• Hallux amputation or total amputation of the foot
• Receiving any physiotherapy intervention or offloading devices
• Neurological or orthopedic impairments
• Major vascular complications
• Severe retinopathy