Effectiveness of Neural Mobilization in improving ankle range of motion and plantar pressure distribution in patients with diabetic peripheral neuropathy: A single group pretest- posttest quasi experimental study
Diabetic peripheral neuropathy is the commonest complication in individuals with type2 diabetes. The severity of neuropathy is seen to be increased along with the duration of diabetes. In previous studies, it was found that ankle mobility is significantly reduced, both dorsiflexion and plantarflexion ranges are affected significantly. Also, the pressure under the different areas of foot is also altered with much higher pressure under certain foot areas which can lead to damage of dermal layers and causing damage and may lead to diabetic ulcers in foot. Neural mobilization is a newer technique which is currently being used for treating Neuro-musculoskeletal conditions and showing good results. In our study, we used neural mobilization to see the effect in improving the ankle mobility and plantar foot pressure distribution in individuals with diabetic peripheral neuropathy. The outcome measures taken was Ankle ROM (Active & Passive) using the universal goniometer and the plantar pressure distribution using Harris mat. The outcome measurements were taken at baseline and at 4 weeks after completion of intervention. For ankle ROM measurements, the participants were taken in siting position. The plantar pressure distribution was taken in dynamic situation where patient was asked to walk on the clear 5 meter path in which Harris mat was placed in between. The procedure was then repeated with another foot.
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The samples were collected using the purposive sampling within the multispecialty hospital setting. All the participants were screened for the eligibility criteria and with prior diagnosis of diabetic peripheral neuropathy. The participants were between 35-75 years of age and without any other systemic or neurological manifestation. The procedure was explained to all the participants and written informed consent was taken. For Ankle range of motion measurements, Universal goniometer was used. Both the active and passive ranges of the experimental limb were taken at the baseline and after 4 weeks. The participants were taken in high sitting position and the fulcrum of goniometer was placed on the lateral malleolus of tibia. The stationary arm was aligned with the lateral midline of the fibula and the moving arm is aligned with the lateral midline of the calcaneus. Then the participant was asked to move the ankle in dorsiflexion and then in plantarflexion. For passive ROM, the therapist moved the foot in dorsiflexion and plantarflexion. Three readings of each measurement were taken, and the average was taken. For plantar pressure measurements, the dynamic pressure was taken with the patient walking on a straight, clear, level path while placing the foot on the Harris mat. The Harris mat was placed on mid-way with a white paper under the properly inked gauze. The procedure was then repeated with another leg. For evaluation of plantar pressure distribution, each foot was divided into 6 regions: upper medial, upper lateral, middle medial, middle lateral, lower medial and lower lateral regions. Then the impressions were scanned using the podia scan software in which the high or low pressure areas were shown as different color regions. Then the pressure in each region was calculated using the reference values.