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To examine the effect of wearing a soft and elevated shoe with a wobbly half-sphere on walking balance in people with Diabetes Neuropathy (DN). The custom-made shoe induces low amplitude perturbations, which provoke proprioception in the ankle joint and increases the recruitment of muscles controlling the ankle joint. Because the ankle joint proprioception is often damaged in people with DN and causes unstable walking balance control, we hypothesized the custom-made shoe that concentrates on walking training on the ankle joint could improve walking balance in DN people.
A nonrandomized controlled pre-post trial.
Diabetes Rehabilitation Center, Tehran University of Medical Science.
We had three groups of participants (10 in each group): A healthy control group and a DN group with walking practice + custom-made footwear, and a DN group with only walking training.
All groups practiced walking for 30 min/day on the treadmill at the preferred speed for 30 sessions (3 times*10 weeks).
Main Outcome Measures
We assessed the average center of pressure (CoP) path length and displacement standard deviation (CoP DispSD) for 15 steps on the force platform and Time Get Up Go (TGUG) pre and post practices.
In the repeated measure ANOVA and the pairwise comparisons, the CoP pathlength increased, CoP DispSD decreased, and TGUG reduced post practices in the DN group with walking + footwear compared to the DN group with only walking practices. The post-assessments in the DN group with walking + footwear were significantly different than the control group post-assessments. The control group did not show any significant pre-post differences. DN groups showed worse balance control in pre-practices than the control group (P < 0.05).
We showed faster walking with improved balance control in DN patients due to walking training with destabilizing ankle joint shoes. These specific shoe features may induce better mobility and lubrication in the glycolyzed ankle joint, increased tolerance and strength of damaged muscles at the ankle joint, and timing and coordination of muscles.
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