Manual Therapy in Diabetic Patients with Tibio-tarsal Dorsiflexion Deficit and Forefoot Overload: A Case Report

Introduction: Limitation of tibio-tarsal joint mobility in diabetic patients can occur within a few years of diagnosis, even in young patients. This joint movement deficit is believed to be due to stiffness in muscles, tendons, joint capsules, ligaments, and skin. With this in mind, the aim of this study is to design an experimental protocol of orthopedic manual therapy and therapeutic exercise in the future for subjects with diabetes, reduced joint mobility, and subsequent insufficient dorsal flexion of the tibio-ankle, and to test the reduced avampodalic pressure that correlates with an increased ulcerative risk. Case presentation: A patient aged 64, male, overweight, family history of type II diabetes, self-employed, and diagnosed with diabetes type 2. Results: The patient was evaluated with inertial motion sensors, a Baropodometric platform, a Lounge test, and MWM. Already after the first session, an improvement in plantar pressures was observed with a decrease both in the peaks from 413.6 Kpa to 99 Kpa in both feet and in the average plantar pressures from 129.8 Kpa to 54.5 Kpa for both feet with a decrease in plantar pressures at the forefoot from 43.7 % to 33.2 %. Tissue elasticity was assessed with the Lunge Test, and increased from 8 cm to 9.5 cm. Conclusion: The results suggest that the role of manual treatment combined with an exercise program could increase tarsal dorsiflexion and consequently decrease plantar pressures.