Effectiveness of a web-based foot-ankle exercises program for treating modifiable risk factors for ulcers in people with diabetic neuropathy: a randomized controlled trial

Abstract The need for strategies to prevent complications arising from diabetic neuropathy (DPN) is well recognized, yet foot-ankle exercises programs present weak to moderate evidence and barriers persist in their implementation, including the democratization of access to exercise programs. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercises program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG;n=31), which received the usual care, or the intervention group (IG;n=31), which received the usual care plus a 12-week foot-ankle exercises program using a web-based software (the SOPeD software). Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program; however, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion during push-off at 24 weeks. Regarding plantar loadings during gait, there was a forefoot pressure reduction at 12 weeks compared to baseline, but at 24 weeks, forefoot loads increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion during gait were noted, mostly at 24 weeks. Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.