Introduction: Non-enzymatic protein glycosylation in diabetic patients leads to stiffening of collagen-containing tissues affecting joint mobility. Motor dysfunction in diabetic patients can be detected as muscle weakness or atrophy.Objective: To determine the presence of muscles weakness and limited joint mobility at ankle (AJ), subtalar (SJ) and first metatarsophalangeal joint (I MTP) in diabetic patients and to determine impact of diabetes duration on those changes.Patients and Methods: A cross-sectional study was conducted among 100 diabetic patients in “Primary Health Care Centre Banjaluka” in 2014. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. Range of motion (ROM) at the AJ, SJ and I MTP was measured with goniometer.Results: The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ (47.85°) was significantly decreased compared to the reference value that is 65° (t =-15.378, P=000). The average ROM at SJ (35.10°) was significantly decreased compared to the reference value that is 50° (t =-15.378, P=000). The average ROM at the I MTP (72.70°) was significantly decreased compared to the reference value that is 120° (t =-15.378, P = ,000).Conclusion: Patients with diabetes have decreased foot and ankle muscle strength, and the average values of the range of motion at AJ, SJ and I MTP, but the duration of the diabetes does not correlate significantly with those changes.

Background: Bracing is an effective treatment for idiopathic scoliosis (IS), and Adherence is one of the most important factors influencing outcomes. However, evidence on the effectiveness of objective monitoring using thermal sensors in everyday clinical settings remains limited. Objective: To evaluate the impact of Adherence and brace-wearing consistency on short-term outcomes in IS patients during growth in a real clinical setting. Methods: This retrospective cohort study included 114 patients (100 with adolescent idiopathic scoliosis (AIS) and 14 with juvenile idiopathic scoliosis (JIS)) treated with a three-dimensional (3D) rigid brace equipped with a thermal sensor. Adherence was calculated as the ratio of actual to prescribed wear time; consistency was defined using the interquartile range (IQR) of daily wear time (IQR ≤ 1 h = consistent). Cobb angle was measured at baseline, in-brace, and after 6 months. Logistic regression, receiver-operating characteristic (ROC) analysis, and general linear model (GLM) analyses were performed, supported by sensitivity analyses, to assess model robustness. Results: Mean Adherence was 85.3 ± 18.9%; high Adherence was observed in 71.4% of JIS and 57.0% of AIS patients, while 19.3% showed high consistency. In-brace correction averaged 52.5 ± 23.2% (68.1% JIS vs. 50.3% AIS; p = 0.007). At 6 months, 55% improved, 42% were stable, and 3% worsened. Adherence was the only significant predictor of consistency (OR = 1.511; 95% CI 1.181–1.933; p = 0.001). The ROC analysis showed excellent discriminative ability (Area Under the Curve (AUC) = 0.908). Adherence category (p = 0.041) and Risser stage (p = 0.041) were significant predictors of short-term outcome. Conclusions: Adherence and brace-wearing consistency are key predictors of short-term bracing outcomes in IS. Objective monitoring with thermal sensors enables precise tracking, improves patient engagement, and supports individualised treatment.

BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints. Evidence shows that a foot-related exercise program, combined with a health-promoting program, can improve the signs and symptoms of diabetic polyneuropathy, enhance gait, restore mobility in the foot and ankle joints, redistribute pressure while walking, and increase foot strength and function. As a result, these exercise programs can help mitigate the risk factors for diabetic foot ulceration. AIM To determine the effect of supervised stretching, strengthening, functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy. METHODS This was a randomized controlled trial conducted in a tertiary hospital. The study included 82 participants allocated into the intervention group (alpha-lipoic acid and exercise on 15 consecutive therapeutic days, n = 42) and control group (alpha lipoic acid only, n = 40). Muscle strength included dorsal and plantar flexors dynamometry and strength score, while range of motion included ankle, subtalar and first metatarsophalangeal joint goniometry. RESULTS Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15 (9.9 ± 7.2 vs 0.1 ± 3.3; P = 0.006) and month 6 (2.8 ± 7.3 vs -0.9 ± 4.1; P < 0.001), subtalar joint on day 15 (7.5 ± 5.1 vs -0.25 ± 2.25; P < 0.001) and month 6 (3.9 ± 6.4 vs -0.13 ± 3.49; P < 0.001). Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15 (2.62 ± 1.69 vs 0.10 ± 1.35; P < 0.001) and month 6 (0.66 ± 2.38 vs -0.75 ± 1.94; P = 0.004) as well as plantar flexors on day 15 (3.3 ± 1.6 vs 0.3 ± 1.5; P < 0.001) and month 6 (1.8 ± 2.2 vs -0.9 ± 2.1; P < 0.001). Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15 (-1.45 ± 1.42 vs -0.03 ± 0.16; P < 0.001) and month 6 (-1.17 ± 1.53 vs 0.20 ± 0.56; P < 0.001). CONCLUSION Exercise in combination with alpha-lipoic acid can improve joint mobility, as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.

BackgroundThe objective of the study was to determine the correlation between the biomechanical parameters: ankle and foot muscle strength, range of motion (ROM) at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) in patients with different diabetic ulcer risk assessed by IWGDF 2019 Guidance risk stratification system.MethodA cross-sectional study included 100 diabetic patients. The patients were classified into 4 risk categories of development of diabetic foot ulcer (DFU) applying IWGDF Guidelines 2019 stratification risk system. The function of ten foot and ankle muscles was evaluated by manual muscle testing and application of the Michigan Diabetic Neuropathy Score (MDNS) system. The range of motion ROM at the ankle, subtalar and first metatarsophalangeal joint was measured with a goniometer. The risk assessment was done applying IWGDF Guidelines 2019 stratification risk system. To test the statistical significance the ANOVA test was applied.ResultsAverage muscle strength in specified categories was category 0:9.2; category 1:13.9; category 2:13.3; category 3:15.2. Average ROM at AJ in specified categories was: category 0:49.3°; category 1:48.8°; category 2:45.5°; category 3:44.6°. Average ROM at SJ in specified categories was: category 0:37.8°; category 1:31.3°; category 2:35°; category 3:28.7°. Average ROM at I MTP in specified categories was: category 0:78.6°; category 1:74.4°; category 2:65.5°; category 3:57.9°. ConclusionThe risk for DFU significantly correlates with foot muscle strength and ROM at SJ, and I MTP, but does not with ROM at AJ.

Background/Aim: Preventing lower limb diabetic complications begins with identifying those at risk for diabetic foot ulceration (DFU). DFU development is related to abnormal pattern of plantar pressure distribution caused by alterations in foot rollover process due to loss of foot-ankle muscular strength, impaired range of motion (ROM) and nervous function, as their integrity is needed to enable proper load absorption on plantar surface. Objective of study was to determine correlation between biomechanical parameters of lower limb: ankle and foot muscle strength, ROM at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) and overall risk for DFU assessed by IWGDF 2019 Guidance risk stratification system. Methods: A cross-sectional study included 100 diabetic patients, both types. Patients were classified into 4 DFU risk categories applying IWGDF Guidelines 2019 stratification risk system. Function of ten foot and ankle muscles was evaluated by manual muscle testing applying Michigan Diabetic Neuropathy Score system and was expressed by muscle score (MS) on dominant leg. ROM at AJ, SJ and I MTP was measured with a goniometer on dominant leg and was expressed by degree (°). Results: Average MS in specified categories were as follows: Category 0: 9.2; Category 1: 13.9; Category 2: 13.3; Category 3: 15.2 and they were significantly different. Average ROM at AJ in specified categories were as follows: Category 0: 49.3°; Category 1: 48.8°; Category 2: 45.5°; Category 3: 44.6° and they were not significantly different. Average ROM at SJ in specified categories were as follows: Category 0: 37.8°; Category 1: 31.3°; Category 2: 35.0°; Category 3: 28.7° and they were significantly different. Average ROM at I MTP in specified categories were as follows: Category 0: 78.60 ; Category 1: 74.4°; Category 2: 65.5°; Category 3: 57.9° and they were significantly different. Conclusions: Risk for DFU ulcer significantly correlates with decreased ankle and foot muscle strength and ROM at SJ and I MTP but does not correlate with ROM at AJ.