A very nice new Australian study has reported that calf muscle stretching alone in people with diabetes does not increase their ankle range of motion nor reduce their forefoot plantar pressures.
This RCT – led by Dr Angela Searle and Prof Viv Chuter from the University of Newcastle – randomised 68 people with diabetes and ankle equinus to receive either a calf stretching program or not. The stretching program involved 2 minutes of static calf muscle stretching per day, 5 days per week, for 8 weeks.
At the end of the program the authors found no differences between the groups receiving the program and those that didn’t for the outcomes of ankle dorsiflexion (non-weight bearing and weight-bearing) or forefoot plantar pressures (in-shoe and barefoot).
While previous studies have shown calf stretching alone improved ankle range of motion in older people without diabetes, the authors conclude this doesn’t seem to be the case in people with diabetes. They suggest this may be because of the effect of neuropathy which half of their participants also had.
The authors recommend that further research should investigate whether different combinations of physical therapy interventions may instead reduce plantar pressure in people with diabetes, such as stretching, strengthening, and joint mobilisation.
Until then, the findings of Drs Searle and Chuter’s very elegantly designed Australian RCT suggests that prescribing calf muscle stretching alone to people at risk of diabetic foot disease does not seem to help reduce forefoot plantar pressures and in turn prevent diabetic foot ulcers.