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balance, diabetes, gait, muscle strength, older adult, plantar cutaneous sensibility, proprioception



  1. Navarro-Peternella, Fabiana Magalhaes PhD
  2. Teston, Elen Ferraz DNP, MSN
  3. dos Santos Santiago Ribeiro, Beatriz Maria RN
  4. Marcon, Sonia Silva PhD


OBJECTIVE: To determine the effect of an intervention involving muscular ankle strengthening and feet sensory stimuli to improve gait speed and balance in older adults with diabetes mellitus type 2 (DM2).


DESIGN: A clinical trial with concealed allocation, assessor blinding, and intention-to-treat analysis.


PARTICIPANTS: The trial enrolled 66 people 60 years or older with DM2 who were physically independent (did not require assistance with activities of daily living).


INTERVENTION: The experimental group performed 12 weeks of plantiflexor and dorsiflexor muscle strengthening exercises with resistance bands, proprioceptive exercises on balance boards and a buoy, and plantar sensory stimulation with bristle brushes and cloths, as well as general foot care instructions. The control group received foot care instructions only.


OUTCOME MEASURES: The primary outcome was plantar cutaneous sensibility as measured with Semmes-Weinstein monofilaments. Secondary outcomes included muscular strength (plantar flexion and dorsiflexion torque as measured with an isokinetic dynamometer), gait speed, and balance (total displacement area, mediolateral displacement, anteroposterior displacement, mediolateral displacement speed, and anteroposterior displacement speed) on right and left bipedal and unipedal supports.


RESULTS: In comparison with the control group, the experimental group demonstrated improved plantar cutaneous sensibility on the right foot (3.46 points; 95% confidence interval [CI], 3.85-9.80), left foot (3.46 points; 95% CI, 4.06-9.76), and an increase in gait speed (0.15 m/s; 95% CI 0.12-0.42). There were no meaningful changes in participants' ankle muscle strength or balance.


CONCLUSIONS: This study showed that plantar cutaneous sensory stimulation can improve foot sensibility and increase the gait speed of older adults with DM2. However, there were no meaningful dorsiflexor or plantiflexor gains after 12 weeks.