Can Muscle Strengthening Relieve Plantar Pressures In Patients With Diabetic Polyneuropathy?

David G. Armstrong DPM MD PhD

For patients with diabetic polyneuropathy, plantar foot ulcers can develop due to higher plantar pressures. Is muscle strengthening the answer to relieving such pressures? The results of a new study in the Journal of Foot and Ankle Research cast some doubt on this question, which many have had for some years.1

The unblinded, randomized, controlled trial focused on patients with diabetes and polyneuropathy. Forty-eight patients received strength training for 24 weeks while 46 had no intervention. Researchers measured plantar pressures in both groups at 0, 12, 24 and 52 weeks. A random intercept model evaluated the effects of the intervention on peak pressures and pressure–time integrals, displacement of center-of-pressure and the forefoot to rearfoot pressure–time integral ratio.

The study found that plantar pressure patterns were not affected by the strength training. The peak pressure and the pressure–time integral under the forefoot increased in each group by 55.7 kPa and 2.0 kPa over 52 weeks, respectively.

I think the learning point from this is not that muscle strengthening doesn't work, but rather that its effects are transient. The study even more supports the adage that "If you don't use it, you lose it."


1. Melai T, Schaper NC, Ijzerman TH, et al. Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial. J Foot Ankle Res. 2013; 6(1):41.

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