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.

糖尿病周围神经病变（Diabetic peripheral neuropathy）是2型糖尿病（type2 diabetes）患者最常见的并发症。神经病变的严重程度随糖尿病病程延长而显著加重。既往研究显示，患者踝关节活动度（ankle mobility）显著降低，背屈（dorsiflexion）与跖屈（plantarflexion）活动范围均受到明显影响。此外，足部不同区域的足底压力（plantar foot pressure）亦出现异常，部分区域压力显著升高，可损伤皮肤真皮层，进而引发足部糖尿病溃疡。神经松动术（neural mobilization）是当前用于治疗神经肌肉骨骼疾病（Neuro-musculoskeletal conditions）的新兴技术，且已展现出良好的临床疗效。本研究采用神经松动术，探究其对糖尿病周围神经病变患者踝关节活动度与足底压力分布的改善效果。本研究的结局指标包括：通过通用量角器（universal goniometer）测量的踝关节主动与被动活动范围（Ankle ROM, Active & Passive），以及采用Harris足底压力垫（Harris mat）采集的足底压力分布。上述指标分别于干预前基线（baseline）阶段及干预完成后4周进行数据采集。踝关节活动范围测量时，受试者取坐位。足底压力分布测量采用动态测试模式：让受试者在铺设了Harris足底压力垫的5米平直通道上行走，随后换侧重复该测试流程。