Effectiveness of a web-based foot-ankle exercises program for treating modifiable risk factors for ulcers in people with diabetic neuropathy: a randomized controlled trial

Effectiveness of a web-based foot-ankle exercises program for treating modifiable risk factors for ulcers in people with diabetic neuropathy: a randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effectiveness of a web-based foot-ankle exercises program for treating modifiable risk factors for ulcers in people with diabetic neuropathy: a randomized controlled trial Jane Suelen S. P. Ferreira, Ronaldo H. Cruvinel-Júnior, Erica Q. Silva, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4413701/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract The need for strategies to prevent complications arising from diabetic neuropathy (DPN) is well recognized, yet foot-ankle exercises programs present weak to moderate evidence and barriers persist in their implementation, including the democratization of access to exercise programs. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercises program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG;n=31), which received the usual care, or the intervention group (IG;n=31), which received the usual care plus a 12-week foot-ankle exercises program using a web-based software (the SOPeD software). Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program; however, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion during push-off at 24 weeks. Regarding plantar loadings during gait, there was a forefoot pressure reduction at 12 weeks compared to baseline, but at 24 weeks, forefoot loads increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion during gait were noted, mostly at 24 weeks. Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019. Health sciences/Diseases/Neurological disorders/Peripheral neuropathies Health sciences/Endocrinology/Endocrine system and metabolic diseases/Diabetes/Diabetes complications Health sciences/Health care/Therapeutics/Rehabilitation Diabetic neuropathies exercise therapy foot-related exercises eHealth rehabilitation technology biomechanics Figures Figure 1 Figure 2 Figure 3 Introduction Diabetic peripheral neuropathy (DPN) is one of the most prevalent comorbidities 1 , 2 and negatively impacts quality of life 3 resulting in loss of protective sensation, vascular problems 4 – 6 , and reduced foot-ankle function and mobility 7 – 9 , which in turn impairs proper foot rollover and plantar pressure distribution during gait 9 – 11 , thus increasing the risk of foot ulcers, infections, and amputations 12 . These risks factors, which are dependent on diabetes progression and DPN severity, call attention to the urgent need to develop and implement evidenced-based preventive measures in health care systems. General preventive and management strategies recommended by the International Working Group on the Diabetic Foot (IWGDF), such as proper glycemic control, adopting a healthy lifestyle, regular foot monitoring, using adequate footwear, and performing specific foot-ankle exercises, can potentially reduce the risk and progression of DPN 13 . However, raising awareness for and adherence to these preventive strategies has been a real challenge 14 , particularly in people with chronic diseases such as diabetes. In addition to depression and anxiety 15 , lack of motivation to exercise, low income, and long distance to treatment facilities are frequent barriers that hinder treatment adherence 16 . In this sense, the use of m-Health/e-Health apps can be promising and cost-effective tools to address the adherence and compliance problems 17 due to their convenience, ubiquity, and accessibility 18 . Although e-health does not completely replace face-to-face care, the use of these apps has the potential to improve patient motivation and protagonism, health outcomes, a broader access to health care treatments 19 – 21 , and may reduce health care costs due to diabetes 22 , 23 . Foot-ankle exercises programs are a proven strategy to improve the modifiable risk factors for ulcers in persons with diabetes 24 ; however, a web-based treatment strategy has not yet been tested in this population. Therefore, we conducted a superiority randomized controlled, single-blinded, two parallel arm trial, the FOotCAre trial I (FOCA-I), to investigate the effectiveness of a 12-week customized web-based foot-ankle therapeutic exercises program based on the Sistema de Orientação ao Pé Diabético software (SOPeD; translation: Diabetic Foot Guidance System ; www.soped.com.br ) on DPN symptoms and severity in people with DPN (categories 1 and 2 according to the IWGDF risk classification). The secondary aims were to investigate the effectiveness of this intervention at 12 and 24 weeks on foot-ankle biomechanics and plantar pressure during gait, tactile and vibration sensitivities, foot health and functionality, foot strength, and functional balance. Methods Study Design The FOCA-I trial was designed and reported in accordance with the CONSORT guidelines 25 , received approval on May 10, 2019 from the Ethics Committee of the School of Medicine, University of São Paulo (CAAE:90331718.4.0000.0065), and was registered at ClinicalTrials.gov on July 8, 2019(NCT04011267). The trial was carried out at the Physical Therapy Department of the School of Medicine of the University of São Paulo and the methodology and protocol have been extensively explained elsewhere 26 . Briefly, 62 eligible patients categorized as IWGDF risk category 1 or 2 were randomized 1:1 (computer-generated randomization sequence in blocks of four to eight 27 ) to receive either the protocol intervention or usual-care for 12 weeks. Only the physiotherapist responsible for prescribing the intervention was aware of group allocation, and participant names were encoded, sealed in an opaque envelope, and concealed from the study statistician and from two other researchers responsible for all assessments. Participants and recruitment The participants were recruited from August 1, 2019 to February 1, 2022 through digital social media advertising, from the database of the Endocrinology Outpatient Clinic of the Hospital das Clínicas (School of Medicine, University of São Paulo), and via a population campaign organized by the Brazilian Diabetes Care Association. We recruited a total of 62 adults of both sexes between the ages of 18 and 65 who had a clinical diagnosis of type 1 or 2 diabetes; confirmed DPN using fuzzy software ( www.usp.br/labimph/fuzzy ; score ≥ 2); and who could walk independently for at least 10m (Fig. 1 ). Individuals with the following characteristics were not included: amputation of any part of the foot; an active ulcer; a history of foot, ankle, knee, or hip surgical procedures or indication of surgery or arthroplasty; arthroplasty and/or orthosis of the lower limbs; a diagnosis of any severe neurological disease unrelated to diabetes; presence of dementia or inability to provide consistent information; receiving any physiotherapy or using offloading devices during the study period; use of walking aids; major vascular complications and/or severe retinopathy, as indicated in medical records. In addition, all eligible participants had to have digital literacy. Each eligible participant received a thorough explanation from the main researcher about all the stages of the study, including the assessment and follow-up process, possible risks, and lack of compensation or benefits. After agreeing to participate, participants signed an informed consent form approved by the Ethics committee. Treatment arms The control(CG) and intervention groups(IG) participants received self-care education and a self-management consultation from the main researcher, as well as a personalized brochure containing summarized self-care instructions, as recommended by the IWGDF guidelines 24 . Participants of both groups continued their medical and pharmacological treatments provided by the health care team. The IG participants followed a web-based foot-ankle exercises program based on the SOPeD software three sessions per week for 12 weeks (total of 36 sessions). Each session lasted approximately 20 to 30 minutes and was comprised of eight exercises that could be done at the participant’s convenient time and place. The SOPeD contains a total of 39 different exercises (considering their sub-level progressions, a total of 104 variations) for the intrinsic and extrinsic foot muscles and foot-ankle joints, including warm-up, stretching, strengthening, and functional exercises, such as balance and gait training (see supplementary material). Exercise intensity and complexity were personalized based on the individual’s perceived effort as determined by the software algorithm; detailed information about the software’s components and structure can be found elsewhere 26 , 28 . In the first face-to-face session, the physiotherapist provided individualized care to the IG participants, during which the participants were registered in the SOPeD database and received a kit containing materials for performing the exercises. As for the remaining 35 sessions, the participants performed the exercises without face-to-face supervision, but the main physiotherapist contacted the participants by phone every week to check on their progress and address any potential issue. Participants were advised to discontinue the exercises and inform the main physiotherapist if they experienced cramps, intense pain, excessive fatigue, or any other discomfort. After 12 weeks, the IG were encouraged to continue with the exercises program at the SOPeD until the end of the study (24 weeks), and their use of the software were remotely monitored by the administrator area in the software. Assessments The primary outcomes were DPN symptoms and severity. DPN symptoms were assessed using the Brazilian version of the Michigan Neuropathy Screening Instrument 29 . Scores range from 0 to 13, with a higher score indicating worse symptoms. DPN severity was determined using the Decision Support System for Classification of Diabetic Polyneuropathy ( www.usp.br/labimph/fuzzy ) 30 . Scores range from 0 to 10, with higher scores indicating more severe DPN. The secondary outcomes were DPN-related outcomes, functional outcomes, and gait biomechanics. The DPN-related outcomes were tactile sensitivity of four plantar areas as assessed by a 10-g monofilament 31 and vibration perception of the first metatarsophalangeal joint as assessed by a 128-Hz tuning fork 32 . Functional outcomes were foot foot pain, function, health and shoes as assessed by the Brazilian version of the Foot Health Status Questionnaire 33 toes and hallux isometric muscle strength as assessed by a pressure plate (emed-q 100; Novel GmbH, Munich, Germany) 34 , and functional balance as assessed via the functional reach test 35 . Gait biomechanics variables included foot-ankle, hip, and knee kinematics; ankle, hip, and knee kinetics calculated by Motion Capture Nexus 2.6 software (Oxford Metrics); and plantar pressure during gait. The biomechanics of walking were measured employing a standard gait analysis system composed by eight infrared cameras (at a 100-Hz, Vicon VERO; Oxford Metrics, Oxford, UK) and a force plate (at 1000-Hz frequency, AMTI OR-6-1000; AMTI, Watertown, MA, USA). A total of 42 passive reflective markers were placed on both lower limbs following the setup protocols of Plug-In Gait and the Oxford Foot Model 36 . Participants were instructed to walk at a self-selected comfortable speed along a 10-m track. The speed was controlled to ensure consistent speed across all assessments (baseline, 12-week, and 24-week), with a maximum deviation of 5% between measurements. Five valid gait cycles (strides) were recorded during walking, and the average of the right and left sides was used for statistical analysis 37 . Ankle power was calculated as the product between joint moment and angular velocity in the sagittal plane. Peak pressure, pressure-time integral, and contact area were recorded before the gait analysis using the emed-q pressure platform at a frequency of 100Hz. Participants walked barefoot over the platform at a self-selected comfortable speed for six trials. A geometric mask in the Novel software was used to assess five plantar regions of interest: hindfoot, midfoot, forefoot, hallux and toes. The average of the six trials for each side (right/left) was used for statistical analysis 37 . Sample size calculation and statistical analysis The sample size calculation was performed, for a F test design for within and between differences, power of 0.80, alpha of 0.05, effect size of 0.20, and a small effect size of 0.20 for the outcomes, resulting in 52 individuals. The final sample size was 62 patients considering a dropout rate of 20%. Generalized estimating equations using a gamma distribution were employed to estimate between-group differences and 95% confidence intervals in the SPSS software v.31 (IBMCorp. Armonk, NY). Q-Q plots were generated to assess the normality of each model. Post-hoc tests for pairwise comparisons were performed with Bonferroni correction. Results Participants’ characteristics were similar at baseline (Table 1). The dropout rate, referring to participants who failed to attend the 12- and 24-week follow-up assessments, was 19% (n=6) in the IG and 16% (n=5) in the CG (18% of total sample). Moreover, one participant in the IG did not attend the 24-week assessment, and one participant in the CG did not attend the 12-week assessment. Additionally, two participants in the CG did not attend the 24-week assessment. The reasons for the dropout rate are described in Figure 1. Two IG participants experienced mild adverse effects during intervention, such as delayed onset muscle soreness and foot muscle cramping; however, neither of them withdrew from the trial due to these effects. The compliance rate 38 (% of IG that completed the exercises program 3 times/week for 12 weeks) obtained from the SOPeD user bank, which included all sessions completed, was 53% and the adherence rate (% of IG that completed the exercises program at 12 weeks) was 84%. Table 1 After 12 and 24 weeks, there were no interaction effects for any DPN-related or functional outcomes; however, there were group and time effects for these outcomes (Table 2). The within-group analysis demonstrated a reduction in DPN symptoms within both the IG (posthoc: p=0.004) and CG (posthoc: p=0.036) after 24 weeks compared to baseline (time effect: p=0.001). The between-group analysis showed a reduction in foot pain in the IG at 24 weeks compared to the CG (group effect: p=0.047; posthoc: p=0.014) and a reduction in foot pain in the IG at 12 weeks (posthoc: p=0.001) and 24 weeks (posthoc: p=0.001) compared to baseline (time effect: p<0.001). The within-group analysis demonstrated an improvement in foot function in the IG at 24 weeks compared to baseline (time effect: p=0.037; posthoc: p=0.009). There was an increase in foot function in the IG compared to the CG at 24 weeks (group effect: p=0.043; posthoc: p=0.013). The between-group analysis also revealed an increase in the functional reach test in the IG compared to the CG at 12 weeks (group effect: p=0.046; posthoc: p=0.049). Table 2 There was an interaction effect in the pressure-time integral at 24 weeks (interaction effect: p=0.008; posthoc: p=0.018), with an increase at the forefoot in the IG compared to the CG (Table 3). In addition, there were significant group and time effects for other plantar pressure outcomes. The within-group analysis demonstrated a reduction in the forefoot peak pressure in the IG after 12 weeks compared to baseline (time effect: p=0.027; posthoc: p=0.044). However, at 24 weeks, there was an increase in the forefoot peak pressure in the IG compared to baseline (time effect: p=0.027; posthoc: p=0.026) and compared to the CG (group effect: p=0.049; posthoc: p=0.022). It is important to highlight that the mean difference reduction in the peak pressure from baseline to 12-week was 283kPa, the mean difference increase from baseline to 24-week was 128kPa, and the mean difference increase at 24-week between the IG and CG was 157kPa. Thus, the reduction obtained after the exercises program was completed was greater than the subsequent increase at 24-week. The between-group analysis showed a reduction in the midfoot pressure-time integral in the IG compared to the CG after 12 weeks (group effect: p=0.047; posthoc: p=0.038). Table 3 There was an interaction effect in the hip flexor moment at 12-week compared to baseline (interaction effect: p=0.001; posthoc: p=0.003), with a significant reduction in the CG at heel strike (Figure 2, Table 4). There was a significant increase in the hip extensor moment at push-off in the CG at 24-week compared to baseline (time effect: p=0.001; posthoc: p=0.001). The within-group analysis demonstrated an increase in the ankle range of motion (ROM) in the IG at 24 weeks compared to 12 weeks (time effect: p=0.001; posthoc: p=0.018) (Figure 3, Table 4). There was also a significant increase in the ankle ROM in the CG at 12 weeks compared to 24 weeks (time effect: p=0.001; posthoc: p=0.023) and at 24 weeks compared baseline (posthoc: p=0.043). The IG showed a significantly increased ankle plantarflexion motion at push-off compared to the CG at 24 weeks (group effect: p=0.038; posthoc: p=0.001). There was also a significant reduction in the minimum arch height in the IG at 12 weeks compared to baseline (group effect: p=0.047; posthoc: p=0.029). Table 4 Discussion We conducted a randomized controlled trial (FOCA-I), to investigate the effectiveness of a 12-week customized web-based foot-ankle therapeutic exercises program on DPN and the program resulted in small-scale functional, clinical and biomechanical effects at 12 and 24 weeks. In the IG, the primary outcomes (DPN symptoms and severity) did not change after 12 weeks of the foot-ankle program, but the secondary outcome functional balance improved at 12 weeks, foot pain decreased and foot function improved at 24-week compared to CG. Regarding plantar loadings during gait, the 12-week program resulted in a reduction in the forefoot peak pressure compared to baseline. However, at 24 weeks, the plantar loads at the forefoot increased in the IG compared to the CG. There was also a gain in the IG in the plantarflexion at push-off at the 24-week follow-up compared to the CG. Some of the effects (DPN symptoms, ankle ROM, hip moment at push-off and heel-strike) were also observed in the CG, suggesting a placebo effect probably resulting from therapist–patient interactions 39 . There was a very good adherence rate to the proposed intervention (84% of IG), despite the recognized high non-adherence to self-managed home-based physical rehabilitation programs 40 . However, there was a relatively low compliance rate (53% of the IG completed 3 sessions/week for 12 weeks), which might have impacted the effectiveness of the intervention. Nevertheless, we surprisingly noticed a trend toward continued treatment beyond the initial intervention period, with approximately 50% of the participants continuing to use the SOPeD after the proposed 12 weeks. This sustained usage of the web-based tool may explain some of the continued changes in the primary (DPN symptoms) and secondary (foot pain, ankle motion, and pressure parameters) outcomes even after the 12-week period. The SOPeD markedly enhanced foot pain and function compared to usual care, suggesting its effectiveness. An IWGDF meta-analysis revealed that foot-ankle exercises programs can improve joint mobility and alleviate DPN signs and symptoms 13 . Notably, the analyzed interventions in the IWGDF meta-analysis lacked the incorporation of rehabilitation technology, such as web-based programs. Foot-ankle exercises through a web-based software like SOPeD seem equally effective as face-to-face or home-based therapeutic programs shown in the literature 13 . The improvements in the DPN-related and functional/motion outcomes, while modest and predominantly observed at 24 weeks, demonstrated the effectiveness of the exercises program in alleviating DPN-related pain and enhancing foot function. These results suggest that the effects of the program could be more pronounced over time, requiring a longer intervention duration for a more noticeable clinical improvement. Earlier studies 41 – 43 support the positive impact of foot-ankle exercises on DPN symptoms, which aligns with our findings. However, it is possible that the progression of DPN symptoms is complex, and other factors may have interfered with these changes throughout the study period. The improvement in DPN symptoms for both groups at 24 weeks compared to baseline might be attributed to improvements in glycemia control, as higher glycemic levels correspond to more severe DPN-related symptoms 44 , 45 . Unfortunately, this study lacked metabolic control over the 24-week period, making it challenging to solely credit the foot-ankle exercises program for the improvement in DPN symptoms. High peak pressures are recognized risk factors for ulcers in individuals with DPN 46 – 48 . Therefore, it is recommended that these plantar loadings 49 be monitored to maintain them within a safe threshold below 200kPa when wearing footwear 24 and below 402kPa when barefoot 50 . The IG exhibited a mean difference reduction in forefoot peak pressure of 283kPa from baseline to 12 weeks; however, at the 24-week follow-up, there was an increase in forefoot peak pressure compared to both the baseline (128kPa) and the CG (157kPa). Clearly, attention should be paid to keeping plantar pressures below the ulcer risk thresholds, however this modification may be linked to the gain in ankle ROM and plantarflexion during push-off in the IG, manifesting only after 24 weeks of intervention, which is a positive result. The exercises program may have led to an improvement in the foot rollover due to the gain in the ankle motion and shifted more pressure towards the forefoot region. The increase in the forefoot plantar loads after 24 weeks of intervention may suggest a delayed response or long-term adaptation to the program. It is possible that the body underwent an adjustment period before fully demonstrating the program's benefits. It is also worth mentioning that the participants' body weight remained almost unchanged throughout the 24 weeks of the study, suggesting that it had no impact on the plantar pressure distribution. At the 24-week follow-up, IG showed an increase in both ankle ROM compared to the 12-week assessment and in plantarflexion at push-off compared to the CG, suggesting a greater ankle contribution in the push-off phase, which potentially changed the foot rollover process. Moderate evidence supports the efficacy of foot-ankle exercises programs in enhancing foot-ankle ROM 13 , as confirmed by our findings. Individuals with DPN exhibit limitations in dynamic dorsi and plantarflexion 9 , 51 , 52 , as well as passive ankle ROM 53 . These motion restrictions can significantly impact the foot rollover pattern during locomotor activities, affecting the load distribution under the foot, as well as balance control. Thus, gaining joint ROM and a pressure redistribution during gait might be seen as a positive outcome. Additionally, CG showed a reduced hip flexor moment at heel strike at 12 weeks, an increased ankle ROM at 12 and 24 weeks, and an increased hip extensor moment at push-off at 24 weeks compared to baseline. These positive outcomes in CG might imply either an effect resulting from usual care received or a placebo effect resulting from professional care and confident patient–therapist interactions 39 , in which mere participation and standard care instructions could yield positive results. Although treatment programs of 8 to 12 weeks are recommended by the IWGDF (2023) 24 prevention guidelines, our findings suggest that the proposed intervention duration (12-week) may not have been sufficient to produce significant changes in the analyzed outcomes. A longer intervention period may be necessary for the beneficial effects to become more evident and consistent, particularly in a web-based program. Strengths and limitations This study's strengths lie in its rigorous methodological design and the provision of a free, globally accessible web-based exercises program, fostering equity, ubiquity and health awareness for individuals with DPN, which is essential for self-care maintenance. Notably, this is the first studyto test specific foot-ankle exercises conducted through a personalized web-based platform for people with diabetes. However, limitations include the lack of direct supervision hindering control over participants' exercises completion and performance. Closer supervision might have ensured better exercise performance and, consequently, greater clinical, functional, and biomechanical gains. Additionally, the study did not monitor metabolic control, potentially impacting DPN-related outcomes. The COVID-19 posed challenges, leading to higher lost-to-follow-up rates, highlighting the need for innovative web-based interventions in global healthcare systems. Conclusions Our 12-week web-based foot-ankle therapeutic exercises program (SOPeD) was feasible, acceptable, demonstrating safety with minimal adverse events, and had a very good patient adherence. Improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion during gait were noted, but were modest overall, which might indicate a need for a longer and more intense web-based exercises program to achieve more pronounced outcomes in foot-ankle biomechanics and plantar pressure for individuals with DPN. Given the relatively low cost and high benefits of a web-based ankle-foot therapeutic exercises program, we humbly invite researchers and clinicians to replicate it and we will offer help if needed. Declarations Acknowledgments The authors would like to thank Professor Ana Claudia Latronico Xavier and the Diabetes Ambulatory activities at Hospital das Clínicas, Faculty of Medicine, University of São Paulo for supporting us with a database of patients with diabetes. Authors Contributions All authors have made substantial contributions to all sections of the manuscript, the conception and design of the study, the acquisition of data, and analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be submitted. JSSPF was responsible for the study design, interpretation of the data, writing the report, submission of the manuscript and management. RHCJr is responsible for the study design, data collection, analysis, and interpretation, writing the report and submission of the manuscript. ESQ and RLM are responsible for the study design, data collection, review and editing. ICNS is responsible for the study design, fundings for the study, interpretation of the data, writing the report and submission of the manuscript. JLV, CG and MD contributed to drafting and revising the manuscript. All authors read, provided feedback and approved the final manuscript. No professional writers have been involved. Data availability statement The datasets generated and/or analyzed during the current study are accessible as anonymized data on the University's public repository at https://repositorio.usp.br/. Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be considered as a potential conflict of interest. Fundings This work was supported by Sao Paulo Research Foundation [FAPESP 2019/02522-0] and by the National Council for Scientific and Technological Development, Brazil (CNPq) [28/2018 FOCA Trial 407252/2018-5]. Monteiro and Cruvinel were supported by FAPESP [2017/17848-3; 2021/00807-8]; Silva and Verissimo were supported by the Agency Coordination of Improvement of Higher Education Personnel (CAPES, financial Code 001). Sacco is supported as a fellow researcher in CNPq, Brazil (Process 302558/2022-5). The funders had no role in the design, execution, interpretation, or writing of the study and did not have any authority over any study activity or in the decision to submit the report for publication. References Pop-Busui, R. et al. Diabetic neuropathy: A position statement by the American diabetes association. Diabetes Care 40, 136–154 (2017). Gordois, A., Scuffham, P., Shearer, A., Oglesby, A. & Tobian, J. A. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care 26, 1790–1795 (2003). Ernandes, R. de C. et al. Impact of Diabetic Neuropathy on Quality of Life and Postural Balance in Brazilian Older Adults. Acta Ortop Bras 28, 275–279 (2020). 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Diabetes Therapy 8, 1253–1264 (2017). Fernando, D. J. S., Masson, E. A., Veves, A. & Boulton, A. J. M. Relationship of Limited Joint Mobility to Abnormal Foot Pressures and Diabetic Foot Ulceration . http://diabetesjournals.org/care/article-pdf/14/1/8/440238/14-1-8.pdf . Martinelli, A. R. et al. Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies. Foot 23, 17–21 (2013). Tables Table 1: Demographics, anthropometrics, and clinical characteristics of the control and intervention groups participants at baseline (n=62). Intervention Group (n=31) Mean ± SD Control Group (n=31) Mean ± SD Age (years) 52.1 ± 9.3 57.0 ± 9.6 Body mass (kg) 78.8 ± 13.4 85.7 ± 16.3 Height (cm) 167.0 ± 0.1 165.0 ± 0.1 Body mass index (kg/m 2 ) 28.2 ± 4.1 31.7 ± 6.9 Sex (Female = n (%)) 20 (64.5%) 18 (58.0%) Type 2 Diabetes (n (%)) 26 (83.8%) 30 (96.7%) Time of diabetes onset (years) 15.3 ± 9.4 10.3 ± 6.7 Tactile sensitivity (number of areas with loss of protective sensation) a 0 [0-1] 0 [0-0] Vibration perception (n (%)) absent 8 (25.8%) 6 (19.3%) reduced 4 (12.9%) 5 (16.1%) present 19 (61.2%) 20 (64.5%) Recruitment Location (n (%)) University tertiary hospital - Hospital das Clínicas 13 (41.9%) 15 (48.4%) Local and regional population campaign 15 (48.4%) 11 (35.4%) Brazilian Diabetes Care Association 3 (9.7%) 5 (16.2%) Education (n (%)) Elementary education incomplete 2 (6.45%) 2 (6.4%) Elementary education complete 4 (6.45%) 4 (12.9%) High school incomplete 3 (3.22%) 3 (9.67%) High school complete 10 (32.25%) 10 (32.25%) Higher education incomplete 5 (12.9%) 5 (16.12%) Higher education complete 7 (38.7%) 7 (22.58%) Socioeconomic status (n (%)) Less than 1 Brazilian minimum salary/ month 1 (3.22%) 4 (12.9%) 1 to 3 Brazilian minimum salary/ month 14 (45.1%) 19 (61.2%) 3 to 5 Brazilian minimum salary/month 5 (16.1%) 5 (16.1%) Up to 5 Brazilian minimum salary/month 11 (35.4%) 3 (9.7%) DPN symptoms (MNSI score) 6.7 ± 1.9 6.3 ± 1.5 DPN severity (Fuzzy score) 3.9 ± 2.1 3.7 ± 2.0 QALY (EQ-5D score) 0.6 ± 0.1 0.6 ± 0.1 FHSQ (score) Foot pain 46.7 ± 23.0 43.1 ± 25.5 Foot function 70.2 ± 26.5 63.0 ± 29.5 Shoes 55.9 ± 38.7 46.7 ± 41.1 Foot Health 25.5 ± 22.6 24.3 ± 21.8 Data are presented as mean (SD) or as n or %; and median (interquartile range IQR). Abbreviation : MNSI - Michigan Neuropathy Screening Instrument; FHSQ- Foot Health Status Questionnaire; DPN diabetic peripheral neuropathy; QALY - Quality Adjusted Life Years. a Poisson distribution and ordinal logistic models were employed to analyze the variable tactile sensitivity. Table 2. Estimated mean ± standard error (SE) or IQR when applicable, p-values from generalized estimating equation (GEE), and between-group mean differences at 12 and 24 weeks (95% confidence interval) for the DPN-related and functional outcomes in the Intervention Group and Control Group. Intervention Group (n=31) Control Group (n=31) Between-Group Difference (CI 95%) GEE Analysis (p-values) Variables Baseline Estimated 12-week Estimated 24-week Estimated Baseline Estimated 12-week Estimated 24-week Estimated 12-week (Intervention X Control Group) 24-week (Intervention X Control Group) Group Time Group x Time (interaction effect) DPN symptoms (MNSI score, mean±SE) 6.71 ± 0.34 a 5.62 ± 0.54 4.90 ± 0.53 a 6.29 ± 0.27 b 5.59 ± 0.43 5.29 ± 0.33 b 0.03 (-1.33, 1. 39) -0.39 (-1.63, 0.85) 0.977 <0.001 0.554 DPN severity (Fuzzy score, mean±SE) 3.93 ± 0.37 3.22 ± 0.52 2.96 ± 0.56 3.66 ±0.35 3.31 ± 0.37 3.49 ± 0.41 -0.09 (-1.34, 1.16) -0.53 (-1.90, 0.83) 0.796 0.111 0.461 Tactile sensitivity (number of areas [median, IQR]) 0 [0-1] 0 [0-0] 0 [0-0] 0 [0-0] 0 [0-0] 0 [0-0] - - 0.071 0.125 0.397 Vibration perception absent left (number of participants) 9 (29.0%) 3 (9.6%) 2 (6.4%) 5 (16.1%) 4 (12.9%) 3 (9.6%) - - - - - Vibration perception reduced left (number of participants) 3 (9.6%) 6 (19.3%) 2 (6.4%) 2 (6.4%) 4 (12.9%) 3 (9.6%) - - - - - Vibration perception absent right (number of participants) 6 (19.3%) 6 (19.3%) 1 (3.2%) 6 (19.3%) 5 (16.1%) 5 (16.1%) - - - - - Vibration perception reduced right (number of participants) 4 (12.9%) 3 (9.6%) 2 (6.4%) 5 (16.1%) 2 (6.4%) 1 (3.2%) - - - - - FHSQ Foot pain (score, mean±SE) 46.69 ± 4.06 d,e 68.09 ± 5.31 d 71.25 ± 5.58 2,e 46.09 ± 4.30 54.94 ± 5.46 51.06 ± 6.04 2 13.15 (-1.78, 28.09) 20.18 (4.04, 36.33) 2 0.047 0.001 0.078 FHSQ Foot function (score, mean±SE) 70.16 ± 4.69 c 73.13 ± 5.87 84.86 ± 4.46 3,c 63.02 ± 5.21 74.05 ± 5.45 66.40 ± 5.94 3 2.08 (-13.63, 17.79) 18.46 (3.88, 33.04) 3 0.043 0.037 0.093 FHSQ Shoes (score, mean±SE) 69.33 ± 5.90 57.89 ± 7.16 66.15 ± 7.45 65.90 ± 6.90 62.49 ± 6.13 51.58 ± 5.76 -4.60(-23.09, 13.88) 14.56 (-3.90, 33.04) 0.506 0.229 0.176 FHSQ Foot health (score, mean±SE) 34.45 ± 3.96 44.97 ± 5.12 48.38 ± 5.75 32.82 ± 3.85 42.20 ± 4.80 40.31 ± 5.19 0.77 (-13.00, 14.55) 8.07 (-7.11, 23.25) 0.483 0.042 0.648 EQ-5D (score, mean±SE) 0.59 ± 0.03 0.65 ± 0.03 0.63 ± 0.03 0.60 ± 0.03 0.63 ± 0.03 0.57 ± 0.03 0.01 (-0.06, 0.10) 0.05 (-0.04, 0.15) 0.560 0.121 0.272 Hallux strength (%BW, mean±SE) 11.35 ± 0.66 11.19 ± 0.98 11.35 ± 0.81 13.79 ± 1.15 13.47 ± 1.09 11.16 ± 0.67 -2.28 (-5.17, 0.60) 0.19 (-1.86, 2.26) 0.146 0.149 0.113 Toes strength (%BW, mean±SE) 8.28 ± 0.71 8.26 ± 0.75 9.48 ± 0.99 8.95 ± 0.73 8.99 ± 0.74 7.84 ± 1.01 -0.73 (-2.80, 1.33) 1.64 (-1.15, 4.43) 0.936 0.999 0.068 Functional Reach Test (cm, mean±SE) 27.00 ± 1.15 29.71 ± 1.34 1 28.75 ± 1.23 24.58 ± 1.31 26.36 ± 1.04 1 27.44 ± 1.07 3.35 (0.02, 6.68) 1 1.31 (-1.91, 4.52) 0.046 0.066 0.490 Abbreviation: MNSI – Michigan Neuropathy Screening Instrument; FHSQ – Foot Health Status Questionnaire; BW – Body Weight 1 group effect p=0.046, between-group difference at 12-week (post hoc p=0.049) 2 group effect p=0.047, between-group difference at 24-week (post hoc p=0.014) 3 group effect p=0.043, between-group difference at 24-week (post hoc p=0.013) a time effect p<0.001, difference between baseline and 24-week in the intervention group (post hoc p=0.004) b time effect p<0.001, difference between baseline and 24-week in the control group (post hoc p=0.036) c time effect p<0.037, difference between baseline and 24-week in the intervention group (post hoc p=0.009) d time effect p<0.001, difference between baseline and 12-week in the intervention group (post hoc p=0.001) e time effect p<0.001, difference between 12-week and 24-week in the control group (post hoc p=0.001) Table 3. Estimated mean and SE, p-values from GEE, and between-group mean differences at 12 and 24 weeks (95% confidence interval) for the plantar pressure variables during gait in the Intervention Group and Control Group. Intervention Group (n=31) Control Group (n=31) Between-Group Difference (CI 95%) GEE Analysis (p-values) Region of Interest Variables Baseline Estimated mean (SE) 12-week Estimated mean (SE) 24-week Estimated mean (SE) Baseline Estimated mean (SE) 12-week Estimated mean (SE) 24-week Estimated mean (SE) 12-week (Intervention X Control Group) 24-week (Intervention X Control Group) Group Time Group x Time (interaction effect) Hindfoot Contact Area [cm 2 ] 34.1±0.6 34.9±0.7 35.4±0.9 35.1±0.6 35.6±0.8 35.8±0.7 -0.7 (-2.9, 1.4) -0.4 (-2.7, 1.8) 0.414 0.091 0.769 Peak Pressure [kPa] 355.3±14.87 365.1± 20.6 386.4±35.2 343.3±11.7 349.3±14.3 350.8±14.7 15.8 (-33.4, 65.0) 35.6 (-21.6, 92.8) 0.322 0.285 0.569 Pressure-time integral [(kPa)*s] 104.3±4.9 104.1±5.7 107.6±6.0 106.7±4.7 100.0±3.8 107.7±5.0 4.1 (-9.4, 17.6) -0.1 (-15.5, 15.2) 0.927 0.183 0.551 Midfoot Contact Area [cm 2 ] 29.0±1.1 29.9±1.7 27.9±2.0 31.0±1.0 31.3±1.3 32.5±1.5 -1.4 (-5.7, 2.9) -4.7 (-9.6, 0.3) 0.163 0.526 0.122 Peak Pressure [kPa] 184.7±12.8 176.4±12.4 175.0±14.9 194.2±8.9 191.0±12.4 204.1±13.8 -14.6 (-48.9, 19.7) -29.1 (-69.0, 10.8) 0.243 0.685 0.543 Pressure-time integral [(kPa)*s] 70.6±5.8 63.1±5.67 1 71.9±9.4 84.4±5.9 81.6±6.9 1 86.5±6.6 -18.5 (-36.0, -1.0) 1 -14.6 (-37.2, 8.0) 0.047 0.332 0.786 Forefoot Contact Area [cm 2 ] 51.6±1.0 665.5±51.3 53.2± 1.8 53.0±0.9 53.9±1.2 54.2±1.3 -0.3 (-3.9, 3.4) -0.99 (-5.3, 3.3) 0.588 0.192 0.529 Peak Pressure [kPa] 586.7± 37.6 a,b 303.6± 64.5 a 715.0±61.7 2,b 561.3±30.2 594.4±33.4 557.8± 30.4 2 71.0 (-49.0, 191.0) 157.2 (22.4, 292.1) 2 0.049 0.027 0.076 Pressure-time integral [(kPa)*s] 199.9±13.0 217.7±17.7 251.8±22.1 * 203.8±11.1 202.7±11.8 195.2±9.3 * 15.0 (-26.8, 56.8) 56.6 (9.7, 103.5) * 0.208 0.105 0.008 Hallux Contact Area [cm 2 ] 10.3±0.3 10.4±0.4 10.3±0.45 11.0±0.2 11.1±0.3 11.0±0.2 -0.7 (-1.7, 0.3) -0.7 (-1.7, 0.4) 0.072 0.959 0.996 Peak Pressure [kPa] 391.6± 33.2 457.4± 54.3 428.0±62.3 440.9±41.3 403.9±40.5 401.7± 57.1 53.5 (-79.3, 186.4) 26.3 (-139.3, 191.8) 0.869 0.795 0.088 Pressure-time integral [(kPa)*s] 97.6±11.3 106.4±16.1 100.3±19.3 111.7±11.1 95.3±9.5 97.8±13.0 11.0 (-25.6, 47.7) 2.5 (-43.2, 48.1) 0.999 0.815 0.174 Toes Contact Area [cm 2 ] 9.5±0.5 9.7±0.7 10.2±0.8 10.3±0.5 9.8±0.7 10.7±0.8 -0.1 (-2.0, 1.8) -0.5 (-2.7, 1.8) 0.598 0.213 0.603 Peak Pressure [kPa] 172.5±15.2 177.3±22.8 204.1±32.4 199.6±21.5 175.3±27.7 206.1±36.1 1.9 (-68.4, 72.3) -2.0 (96.9, 93.0) 0.786 0.037 0.555 Pressure-time integral [(kPa)*s] 47.1±4.9 44.2±5.2 50.2±6.8 61.9±8.4 49.1±7.9 59.4±11.1 -5.0 (-23.6, 13.6) -9.2 (-34.7, 16.3) 0.305 0.036 0.594 1 group effect p=0.047, between-group difference at 12-week (post hoc p=0.038) 2 group effect p=0.049, between-group difference at 24-week (post hoc p=0.022) * interaction effect p=0.008, group effect p=0.208, between-group difference at 24-week (post hoc p=0.018) a time effect p<0.027, difference between baseline and 12-week in the intervention group (post hoc p=0.044) b time effect p<0.027, difference between baseline and 24-week in the intervention group (post hoc p=0.026) Table 4. Estimated mean and SE, p-values from GEE, and between-group mean difference at 12 and 24 weeks (95% confidence interval) for the hip, knee, and foot-ankle kinematics and hip, knee, and ankle joint kinetics during gait in the Intervention Group and Control Group at baseline and follow-up assessments. Intervention Group (n=31) Control Group (n=31) Between-Group Difference (CI 95%) GEE Analysis (p-values) Variables Baseline Estimated mean (SE) 12-week Estimated mean (SE) 24-week Estimated mean (SE) Baseline Estimated mean (SE) 12-week Estimated mean (SE) 24-week Estimated mean (SE) 12-week (Intervention X Control Group) 24-week (Intervention X Control Group) Group Time Group x Time (interaction effect) ANKLE kinematics and kinetics Ankle ROM (degree) 24.52 ± 0.87 23.49 ± 0.89 c 26.41 ± 1.07 c 23.74 ± 0.55 e 23.88 ± 0.60 d 25.56 ± 0.66 d,e -0.38 (-2.50, 1.72) 0.85 (-1.62, 3.32) 0.665 0.001 0.407 Ankle dorsiflexion at heel strike (degree) 3.90 ± 0.61 3.04 ± 0.57 2.78 ± 0.66 3.13 ± 0.45 4.25 ± 1.06 4.81 ± 0.68 -1.20 (-3.58, 1.16) -2.03 (-3.89, -0.16) 0.222 0.961 0.051 Ankle plantarflexion at push off (degree) 2.00 ± 0.94 2.50 ± 1.17 5.12 ± 0.01 1 4.49 ± 0.64 2.78 ± 0.38 2.30 ± 0.71 1 –0.27 (-2.70, 2.14) 2.82 (1.42, 4.22) 1 0.038 0.298 0.955 Ankle flexor moment at heel strike (Nm/(BM*Height) 0.011±0.005 0.021±0.008 0.014±0.005 0.013±0.005 0.016±0.009 0.022±0.005 0.004 (-0.019, 0.029) -0.008 (-0.024, 0.007) 0.744 0.514 0.693 Ankle extensor moment at push off (Nm/(BM* Height) 1.32 ± 0.03 1.39 ± 0.02 1.38 ± 0.03 1.31 ± 0.02 1.27 ± 0.07 1.36 ± 0.03 0.12 (-0.1, 0.27) 0.02 (-0.07, 0.11) 0.189 0.062 0.353 Ankle peak eccentric power at the push off (W/BM*Height) 2.21 ± 0.07 2.53 ± 0.12 2.42 ± 0.13 2.50 ± 0.12 2.50 ± 0.21 2.54 ± 0.12 0.03 (-0.45, 0.52) -0.11 (-0.47, 0.24) 0.393 0.158 0.260 OXFORD FOOT MODEL kinematics Hindfoot to tibia ROM (degree) 23.22 ± 1.04 23.99 ± 1.39 24.15 ± 1.95 22.63 ± 0.92 24.86 ± 1.05 25.89 ± 1.07 -0.86 (-4.29, 2.55) -1.73 (-6.10, 2.63) 0.666 0.069 0.478 Hindfoot to tibia peak angle (degree) 13.74 ± 1.34 15.95 ± 2.13 11.65 ± 1.31 13.38 ± 0.96 14.86 ± 1.03 14.91 ± 1.14 1.08 (-3.55, 5.73) -3.25 (-6.68, 0.16) 0.557 0.207 0.147 Forefoot to hindfoot ROM (degree) 13.16 ± 0.88 13.69 ± 1.28 13.41 ± 0.78 12.54 ± 0.72 12.63 ± 1.27 12.34 ± 0.69 1.06 (-2.47, 4.60) 1.06 (-0.98, 3.10) 0.364 0.941 0.926 Forefoot to hindfoot peak angle (degree) 8.34 ± 0.75 6.99 ± 0.99 6.70 ± 0.97 7.88 ± 0.70 7.61 ± 0.97 6.65 ± 0.88 -0.61 (-3.33, 2.10) 0.04 (-2.53, 2.63) 0.956 0.031 0.768 Hallux to forefoot ROM (degree) 24.56 ± 1.48 25.56 ± 2.09 24.86 ± 1.71 21.61 ± 1.51 23.70 ± 1.44 22.65 ± 1.20 1.85 (-3.12, 6.84) 2.20 (-1.90, 6.32) 0.173 0.363 0.839 Hallux to forefoot peak angle (degree) 23.96 ± 1.71 26.31 ± 2.33 25.09 ± 1.89 21.96 ± 1.78 22.10 ± 1.91 21.32 ± 1.72 4.21 (-1.70, 10.12) 3.77 (-1.25, 8.79) 0.121 0.668 0.675 Maximum arch height (cm) 11.30 ± 0.33 10.50 ± 0.28 10.60 ± 0.58 11.67 ± 0.29 11.61 ± 0.46 10.78 ± 0.37 -1.10 (-2.18, -0.02) -0.17 (-1.53, 1.17) 0.171 0.129 0.269 Minimum arch height (cm) 8.90 ± 0.29 g 8.13 ± 0.33 g 8.07 ± 0.55 9.28 ± 0.31 9.17 ± 0.45 8.51 ± 0.34 -1.04 (-2.14, 0.06) -0.44 (-1.72, 0.83) 0.154 0.047 0.328 HIP and KNEE Kinetics Hip flexor moment at heel strike (Nm/(BM*Height) 0.21 ± 0.05 0.59 ± 0.16 0.72 ± 0.30 0.59 ± 0.18* 0.30 ± 0.15* 0.60 ± 0.16 0.28 (-0.16, 0.72) 0.12 (-0.55, 0.81) 0.841 0.125 0.001 Hip extensor moment at push off (Nm/(BM* Height) 0.09 ± 0.01 0.07 ± 0.03 0.14 ± 0.04 0.06 ± 0.01 a 0.06 ± 0.03 0.17 ± 0.03 a 0.01 (-0.08, 0.10) -0.03 (-0.14, 0.07) 0.670 0.001 0.296 Knee extensor moment at push off (Nm/(BM* Height) 0.10 ± 0.01 0.11 ± 0.01 0.09 ± 0.01 0.09 ± 0.01 0.09 ± 0.01 0.10 ± 0.01 0.01 (-0.03, 0.05) -0.01 (-0.05, 0.02) 0.993 0.912 0.672 Abbreviation: BM – Body Mass, ROM – Range Of Motion * interaction effect p=0.001, time-difference between baseline and 12-week in the control group (post hoc p=0.003); a time effect p=0.001, time-difference between baseline and 24-week in the control group (post hoc p=0.001); b group effect p=0.037, between-group difference at 24-week (post hoc p=0.029); c time effect p=0.001, difference between12-week and 24-week in the intervention group (post hoc p=0.018); d time effect p=0.001, difference between 12-week and 24-week in the control group (post hoc p=0.023); e time effect p=0.001, difference between baseline and 24-week in the control group (post hoc p=0.043); 1 group effect p=0.038, between-group difference at 24-week (post hoc p=0.001); g time effect p=0.047, difference between baseline and 12-week in the intervention group (post hoc p=0.029) Additional Declarations No competing interests reported. Supplementary Files SUPPLEMENTARYMATERIALEXERCISES.xlsx Cite Share Download PDF Status: Published Journal Publication published 08 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 12 Jul, 2024 Reviews received at journal 25 Jun, 2024 Reviews received at journal 15 Jun, 2024 Reviewers agreed at journal 10 Jun, 2024 Reviewers agreed at journal 06 Jun, 2024 Reviewers invited by journal 06 Jun, 2024 Editor assigned by journal 06 Jun, 2024 Editor invited by journal 27 May, 2024 Submission checks completed at journal 27 May, 2024 First submitted to journal 13 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4413701","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":311518189,"identity":"aa3db85d-e710-4b9d-bf38-66ada529ca3b","order_by":0,"name":"Jane Suelen S. P. Ferreira","email":"","orcid":"","institution":"Faculdade de Medicina da Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Jane","middleName":"Suelen S. P.","lastName":"Ferreira","suffix":""},{"id":311518190,"identity":"c6bb14f7-b149-4e79-bbed-68943abe44a5","order_by":1,"name":"Ronaldo H. Cruvinel-Júnior","email":"","orcid":"","institution":"Faculdade de Medicina da Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Ronaldo","middleName":"H.","lastName":"Cruvinel-Júnior","suffix":""},{"id":311518191,"identity":"629c3968-6f1b-4bdd-a74e-4b9bb51160b0","order_by":2,"name":"Erica Q. Silva","email":"","orcid":"","institution":"Faculdade de Medicina da Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Erica","middleName":"Q.","lastName":"Silva","suffix":""},{"id":311518192,"identity":"d6c41564-ca75-444b-a999-1801dbb8f543","order_by":3,"name":"Jady L. Veríssimo","email":"","orcid":"","institution":"Faculdade de Medicina da Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Jady","middleName":"L.","lastName":"Veríssimo","suffix":""},{"id":311518193,"identity":"dc97a644-645b-49cc-889c-288cc96cb13e","order_by":4,"name":"Renan. L Monteiro","email":"","orcid":"","institution":"Universidade Federal do Amapá","correspondingAuthor":false,"prefix":"","firstName":"Renan.","middleName":"L","lastName":"Monteiro","suffix":""},{"id":311518194,"identity":"058ba324-76cb-4e1d-a451-570dd86bc46d","order_by":5,"name":"Marcos Duarte","email":"","orcid":"","institution":"Universidade Federal do ABC","correspondingAuthor":false,"prefix":"","firstName":"Marcos","middleName":"","lastName":"Duarte","suffix":""},{"id":311518195,"identity":"fc7ca015-0365-48e1-ae76-6efc05d8c1b0","order_by":6,"name":"Claudia Giacomozzi","email":"","orcid":"","institution":"Istituto Superiore di Sanità","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Giacomozzi","suffix":""},{"id":311518196,"identity":"c03d5cd1-9d62-4e42-98f3-7095cac94aaf","order_by":7,"name":"Isabel C. N. Sacco","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqUlEQVRIiWNgGAWjYBACNhiDH0QwNpCiRbKBWC1wYHCAWC187GcPf/hRYydnfCP92QPGHfeIcBhPXppkz7FkY7MbOeYGjGeKidAiwWPGwNtwIHHbjRw2Cca2BKK0GH/8C9SyeUb6M6K1GEiDbNkgkWBGpBaeHDNpGaBfJM68MTdIPEOEFvn2M8Yf3wBDjL8dGGIfdxChBcVGBhI1IKWEUTAKRsEoGAUoAAABkTMRrLlIJwAAAABJRU5ErkJggg==","orcid":"","institution":"Faculdade de Medicina da Universidade de São Paulo","correspondingAuthor":true,"prefix":"","firstName":"Isabel","middleName":"C. N.","lastName":"Sacco","suffix":""}],"badges":[],"createdAt":"2024-05-13 14:00:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4413701/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4413701/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-78188-7","type":"published","date":"2024-11-08T15:58:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58146314,"identity":"164cf581-5918-4ee9-8666-118e60337083","added_by":"auto","created_at":"2024-06-11 18:35:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":239996,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the participant recruitment, assessment, and follow-up process of the FOCA-I trial.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4413701/v1/5f3507f9c525ce33ed2f237e.png"},{"id":58146317,"identity":"71613637-6f6e-4cc8-99e5-b0694756733e","added_by":"auto","created_at":"2024-06-11 18:35:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":160693,"visible":true,"origin":"","legend":"\u003cp\u003eHip, knee, and ankle moments (mean ± 1 SD) during gait cycle (0–100%) in the Intervention Group and Control Group at baseline (blue), after 12 weeks (red), and after 24 weeks (green). The dashed vertical lines represent the average end of the stance phase for each corresponding assessment.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4413701/v1/98bf16ae8143d6a65b7d90af.png"},{"id":58146319,"identity":"89f167e3-0310-4fc2-b862-d59b5c839f26","added_by":"auto","created_at":"2024-06-11 18:35:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":159521,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal hip, knee and ankle angles (mean ± 1 SD) during gait cycle (0–100%) in the Intervention Group and Control Group at baseline (blue), after 12 weeks (red), and after 24 weeks (green). The dashed vertical lines represent the average end of the stance phase for each corresponding assessment.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4413701/v1/c5f9023c960606f2af006ce8.png"},{"id":68750914,"identity":"64ec7eed-b05f-46f0-a7ad-da090b17d638","added_by":"auto","created_at":"2024-11-11 16:12:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1938533,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4413701/v1/4a7ca7f1-863c-4986-b65a-21b7436b44fb.pdf"},{"id":58146318,"identity":"b92b9fab-1624-49d5-85b8-a2ff7c526aaf","added_by":"auto","created_at":"2024-06-11 18:35:25","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12307,"visible":true,"origin":"","legend":"","description":"","filename":"SUPPLEMENTARYMATERIALEXERCISES.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4413701/v1/d17c078d9629a9d56d7316df.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of a web-based foot-ankle exercises program for treating modifiable risk factors for ulcers in people with diabetic neuropathy: a randomized controlled trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetic peripheral neuropathy (DPN) is one of the most prevalent comorbidities\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e and negatively impacts quality of life\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e resulting in loss of protective sensation, vascular problems\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, and reduced foot-ankle function and mobility\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, which in turn impairs proper foot rollover and plantar pressure distribution during gait\u003csup\u003e\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, thus increasing the risk of foot ulcers, infections, and amputations\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. These risks factors, which are dependent on diabetes progression and DPN severity, call attention to the urgent need to develop and implement evidenced-based preventive measures in health care systems.\u003c/p\u003e \u003cp\u003eGeneral preventive and management strategies recommended by the International Working Group on the Diabetic Foot (IWGDF), such as proper glycemic control, adopting a healthy lifestyle, regular foot monitoring, using adequate footwear, and performing specific foot-ankle exercises, can potentially reduce the risk and progression of DPN\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, raising awareness for and adherence to these preventive strategies has been a real challenge\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, particularly in people with chronic diseases such as diabetes. In addition to depression and anxiety\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, lack of motivation to exercise, low income, and long distance to treatment facilities are frequent barriers that hinder treatment adherence\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In this sense, the use of m-Health/e-Health apps can be promising and cost-effective tools to address the adherence and compliance problems\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e due to their convenience, ubiquity, and accessibility\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Although e-health does not completely replace face-to-face care, the use of these apps has the potential to improve patient motivation and protagonism, health outcomes, a broader access to health care treatments\u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, and may reduce health care costs due to diabetes\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFoot-ankle exercises programs are a proven strategy to improve the modifiable risk factors for ulcers in persons with diabetes\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e; however, a web-based treatment strategy has not yet been tested in this population. Therefore, we conducted a superiority randomized controlled, single-blinded, two parallel arm trial, the FOotCAre trial I (FOCA-I), to investigate the effectiveness of a 12-week customized web-based foot-ankle therapeutic exercises program based on the \u003cem\u003eSistema de Orienta\u0026ccedil;\u0026atilde;o ao P\u0026eacute; Diab\u0026eacute;tico\u003c/em\u003e software (SOPeD; translation: \u003cem\u003eDiabetic Foot Guidance System\u003c/em\u003e; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.soped.com.br\" target=\"_blank\"\u003ewww.soped.com.br\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.soped.com.br\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e on DPN symptoms and severity in people with DPN (categories 1 and 2 according to the IWGDF risk classification). The secondary aims were to investigate the effectiveness of this intervention at 12 and 24 weeks on foot-ankle biomechanics and plantar pressure during gait, tactile and vibration sensitivities, foot health and functionality, foot strength, and functional balance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThe FOCA-I trial was designed and reported in accordance with the CONSORT guidelines\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, received approval on May 10, 2019 from the Ethics Committee of the School of Medicine, University of S\u0026atilde;o Paulo (CAAE:90331718.4.0000.0065), and was registered at ClinicalTrials.gov on July 8, 2019(NCT04011267). The trial was carried out at the Physical Therapy Department of the School of Medicine of the University of S\u0026atilde;o Paulo and the methodology and protocol have been extensively explained elsewhere\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Briefly, 62 eligible patients categorized as IWGDF risk category 1 or 2 were randomized 1:1 (computer-generated randomization sequence in blocks of four to eight\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e) to receive either the protocol intervention or usual-care for 12 weeks. Only the physiotherapist responsible for prescribing the intervention was aware of group allocation, and participant names were encoded, sealed in an opaque envelope, and concealed from the study statistician and from two other researchers responsible for all assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and recruitment\u003c/h2\u003e \u003cp\u003e The participants were recruited from August 1, 2019 to February 1, 2022 through digital social media advertising, from the database of the Endocrinology Outpatient Clinic of the Hospital das Cl\u0026iacute;nicas (School of Medicine, University of S\u0026atilde;o Paulo), and via a population campaign organized by the Brazilian Diabetes Care Association. We recruited a total of 62 adults of both sexes between the ages of 18 and 65 who had a clinical diagnosis of type 1 or 2 diabetes; confirmed DPN using fuzzy software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.soped.com.br\" target=\"_blank\"\u003ewww.usp.br/labimph/fuzzy\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.usp.br/labimph/fuzzy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; score\u0026thinsp;\u0026ge;\u0026thinsp;2); and who could walk independently for at least 10m (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Individuals with the following characteristics were not included: amputation of any part of the foot; an active ulcer; a history of foot, ankle, knee, or hip surgical procedures or indication of surgery or arthroplasty; arthroplasty and/or orthosis of the lower limbs; a diagnosis of any severe neurological disease unrelated to diabetes; presence of dementia or inability to provide consistent information; receiving any physiotherapy or using offloading devices during the study period; use of walking aids; major vascular complications and/or severe retinopathy, as indicated in medical records. In addition, all eligible participants had to have digital literacy.\u003c/p\u003e \u003cp\u003eEach eligible participant received a thorough explanation from the main researcher about all the stages of the study, including the assessment and follow-up process, possible risks, and lack of compensation or benefits. After agreeing to participate, participants signed an informed consent form approved by the Ethics committee.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTreatment arms\u003c/h2\u003e \u003cp\u003eThe control(CG) and intervention groups(IG) participants received self-care education and a self-management consultation from the main researcher, as well as a personalized brochure containing summarized self-care instructions, as recommended by the IWGDF guidelines \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Participants of both groups continued their medical and pharmacological treatments provided by the health care team.\u003c/p\u003e \u003cp\u003eThe IG participants followed a web-based foot-ankle exercises program based on the SOPeD software three sessions per week for 12 weeks (total of 36 sessions). Each session lasted approximately 20 to 30 minutes and was comprised of eight exercises that could be done at the participant\u0026rsquo;s convenient time and place. The SOPeD contains a total of 39 different exercises (considering their sub-level progressions, a total of 104 variations) for the intrinsic and extrinsic foot muscles and foot-ankle joints, including warm-up, stretching, strengthening, and functional exercises, such as balance and gait training (see supplementary material). Exercise intensity and complexity were personalized based on the individual\u0026rsquo;s perceived effort as determined by the software algorithm; detailed information about the software\u0026rsquo;s components and structure can be found elsewhere \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the first face-to-face session, the physiotherapist provided individualized care to the IG participants, during which the participants were registered in the SOPeD database and received a kit containing materials for performing the exercises. As for the remaining 35 sessions, the participants performed the exercises without face-to-face supervision, but the main physiotherapist contacted the participants by phone every week to check on their progress and address any potential issue. Participants were advised to discontinue the exercises and inform the main physiotherapist if they experienced cramps, intense pain, excessive fatigue, or any other discomfort. After 12 weeks, the IG were encouraged to continue with the exercises program at the SOPeD until the end of the study (24 weeks), and their use of the software were remotely monitored by the administrator area in the software.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAssessments\u003c/h2\u003e \u003cp\u003eThe primary outcomes were DPN symptoms and severity. DPN symptoms were assessed using the Brazilian version of the Michigan Neuropathy Screening Instrument\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Scores range from 0 to 13, with a higher score indicating worse symptoms. DPN severity was determined using the Decision Support System for Classification of Diabetic Polyneuropathy (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.soped.com.br\" target=\"_blank\"\u003ewww.usp.br/labimph/fuzzy\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.usp.br/labimph/fuzzy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e)\u003csup\u003e30\u003c/sup\u003e. Scores range from 0 to 10, with higher scores indicating more severe DPN. The secondary outcomes were DPN-related outcomes, functional outcomes, and gait biomechanics. The DPN-related outcomes were tactile sensitivity of four plantar areas as assessed by a 10-g monofilament\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and vibration perception of the first metatarsophalangeal joint as assessed by a 128-Hz tuning fork\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Functional outcomes were foot foot pain, function, health and shoes as assessed by the Brazilian version of the Foot Health Status Questionnaire\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e toes and hallux isometric muscle strength as assessed by a pressure plate (emed-q 100; Novel GmbH, Munich, Germany)\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, and functional balance as assessed via the functional reach test\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Gait biomechanics variables included foot-ankle, hip, and knee kinematics; ankle, hip, and knee kinetics calculated by Motion Capture Nexus 2.6 software (Oxford Metrics); and plantar pressure during gait.\u003c/p\u003e \u003cp\u003eThe biomechanics of walking were measured employing a standard gait analysis system composed by eight infrared cameras (at a 100-Hz, Vicon VERO; Oxford Metrics, Oxford, UK) and a force plate (at 1000-Hz frequency, AMTI OR-6-1000; AMTI, Watertown, MA, USA). A total of 42 passive reflective markers were placed on both lower limbs following the setup protocols of Plug-In Gait and the Oxford Foot Model\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Participants were instructed to walk at a self-selected comfortable speed along a 10-m track. The speed was controlled to ensure consistent speed across all assessments (baseline, 12-week, and 24-week), with a maximum deviation of 5% between measurements. Five valid gait cycles (strides) were recorded during walking, and the average of the right and left sides was used for statistical analysis\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Ankle power was calculated as the product between joint moment and angular velocity in the sagittal plane.\u003c/p\u003e \u003cp\u003ePeak pressure, pressure-time integral, and contact area were recorded before the gait analysis using the emed-q pressure platform at a frequency of 100Hz. Participants walked barefoot over the platform at a self-selected comfortable speed for six trials. A geometric mask in the Novel software was used to assess five plantar regions of interest: hindfoot, midfoot, forefoot, hallux and toes. The average of the six trials for each side (right/left) was used for statistical analysis\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation and statistical analysis\u003c/h2\u003e \u003cp\u003eThe sample size calculation was performed, for a F test design for within and between differences, power of 0.80, alpha of 0.05, effect size of 0.20, and a small effect size of 0.20 for the outcomes, resulting in 52 individuals. The final sample size was 62 patients considering a dropout rate of 20%. Generalized estimating equations using a gamma distribution were employed to estimate between-group differences and 95% confidence intervals in the SPSS software v.31 (IBMCorp. Armonk, NY). Q-Q plots were generated to assess the normality of each model. Post-hoc tests for pairwise comparisons were performed with Bonferroni correction.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants\u0026rsquo; characteristics were similar at baseline (Table 1). The dropout rate, referring to participants who failed to attend the 12- and 24-week follow-up assessments, was 19% (n=6) in the IG and 16% (n=5) in the CG (18% of total sample). Moreover, one participant in the IG did not attend the 24-week assessment, and one participant in the CG did not attend the 12-week assessment. Additionally, two participants in the CG did not attend the 24-week assessment. The reasons for the dropout rate are described in Figure 1. Two IG participants experienced mild adverse effects during intervention, such as delayed onset muscle soreness and foot muscle cramping; however, neither of them withdrew from the trial due to these effects.\u003c/p\u003e\n\u003cp\u003eThe compliance rate\u003csup\u003e38\u003c/sup\u003e (% of IG that completed the exercises program 3 times/week for 12 weeks) obtained from the SOPeD user bank, which included all sessions completed, was 53% and the adherence rate (% of IG that completed the exercises program at 12 weeks) was 84%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter 12 and 24 weeks, there were no interaction effects for any DPN-related or functional outcomes; however, there were group and time effects for these outcomes (Table 2). The within-group analysis demonstrated a reduction in DPN symptoms within both the IG (posthoc: p=0.004) and CG (posthoc: p=0.036) after 24 weeks compared to baseline (time effect: p=0.001). The between-group analysis showed a reduction in foot pain in the IG at 24 weeks compared to the CG (group effect: p=0.047; posthoc: p=0.014) and a reduction in foot pain in the IG at 12 weeks (posthoc: p=0.001) and 24 weeks (posthoc: p=0.001) compared to baseline (time effect: p\u0026lt;0.001). The within-group analysis demonstrated an improvement in foot function in the IG at 24 weeks compared to baseline (time effect: p=0.037; posthoc: p=0.009). There was an increase in foot function in the IG compared to the CG at 24 weeks (group effect: p=0.043; posthoc: p=0.013). The between-group analysis also revealed an increase in the functional reach test in the IG compared to the CG at 12 weeks (group effect: p=0.046; posthoc: p=0.049).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was an interaction effect in the pressure-time integral at 24 weeks (interaction effect: p=0.008; posthoc: p=0.018), with an increase at the forefoot in the IG compared to the CG (Table 3). In addition, there were significant group and time effects for other plantar pressure outcomes. The within-group analysis demonstrated a reduction in the forefoot peak pressure in the IG after 12 weeks compared to baseline (time effect: p=0.027; posthoc: p=0.044). However, at 24 weeks, there was an increase in the forefoot peak pressure in the IG compared to baseline (time effect: p=0.027; posthoc: p=0.026) and compared to the CG (group effect: p=0.049; posthoc: p=0.022). It is important to highlight that the mean difference reduction in the peak pressure from baseline to 12-week was 283kPa, the mean difference increase from baseline to 24-week was 128kPa, and the mean difference increase at 24-week between the IG and CG was 157kPa. Thus, the reduction obtained after the exercises program was completed was greater than the subsequent increase at 24-week. The between-group analysis showed a reduction in the midfoot pressure-time integral in the IG compared to the CG after 12 weeks (group effect: p=0.047; posthoc: p=0.038).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was an interaction effect in the hip flexor moment at 12-week compared to baseline (interaction effect: p=0.001; posthoc: p=0.003), with a significant reduction in the CG at heel strike (Figure 2, Table 4). There was a significant increase in the hip extensor moment at push-off in the CG at 24-week compared to baseline (time effect: p=0.001; posthoc: p=0.001). The within-group analysis demonstrated an increase in the ankle range of motion (ROM) in the IG at 24 weeks compared to 12 weeks (time effect: p=0.001; posthoc: p=0.018) (Figure 3, Table 4). There was also a significant increase in the ankle ROM in the CG at 12 weeks compared to 24 weeks (time effect: p=0.001; posthoc: p=0.023) and at 24 weeks compared baseline (posthoc: p=0.043). The IG showed a significantly increased ankle plantarflexion motion at push-off compared to the CG at 24 weeks (group effect: p=0.038; posthoc: p=0.001). There was also a significant reduction in the minimum arch height in the IG at 12 weeks compared to baseline (group effect: p=0.047; posthoc: p=0.029).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe conducted a randomized controlled trial (FOCA-I), to investigate the effectiveness of a 12-week customized web-based foot-ankle therapeutic exercises program on DPN and the program resulted in small-scale functional, clinical and biomechanical effects at 12 and 24 weeks. In the IG, the primary outcomes (DPN symptoms and severity) did not change after 12 weeks of the foot-ankle program, but the secondary outcome functional balance improved at 12 weeks, foot pain decreased and foot function improved at 24-week compared to CG. Regarding plantar loadings during gait, the 12-week program resulted in a reduction in the forefoot peak pressure compared to baseline. However, at 24 weeks, the plantar loads at the forefoot increased in the IG compared to the CG. There was also a gain in the IG in the plantarflexion at push-off at the 24-week follow-up compared to the CG. Some of the effects (DPN symptoms, ankle ROM, hip moment at push-off and heel-strike) were also observed in the CG, suggesting a placebo effect probably resulting from therapist\u0026ndash;patient interactions\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere was a very good adherence rate to the proposed intervention (84% of IG), despite the recognized high non-adherence to self-managed home-based physical rehabilitation programs\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. However, there was a relatively low compliance rate (53% of the IG completed 3 sessions/week for 12 weeks), which might have impacted the effectiveness of the intervention. Nevertheless, we surprisingly noticed a trend toward continued treatment beyond the initial intervention period, with approximately 50% of the participants continuing to use the SOPeD after the proposed 12 weeks. This sustained usage of the web-based tool may explain some of the continued changes in the primary (DPN symptoms) and secondary (foot pain, ankle motion, and pressure parameters) outcomes even after the 12-week period.\u003c/p\u003e \u003cp\u003eThe SOPeD markedly enhanced foot pain and function compared to usual care, suggesting its effectiveness. An IWGDF meta-analysis revealed that foot-ankle exercises programs can improve joint mobility and alleviate DPN signs and symptoms \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Notably, the analyzed interventions in the IWGDF meta-analysis lacked the incorporation of rehabilitation technology, such as web-based programs. Foot-ankle exercises through a web-based software like SOPeD seem equally effective as face-to-face or home-based therapeutic programs shown in the literature \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe improvements in the DPN-related and functional/motion outcomes, while modest and predominantly observed at 24 weeks, demonstrated the effectiveness of the exercises program in alleviating DPN-related pain and enhancing foot function. These results suggest that the effects of the program could be more pronounced over time, requiring a longer intervention duration for a more noticeable clinical improvement. Earlier studies\u003csup\u003e\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e support the positive impact of foot-ankle exercises on DPN symptoms, which aligns with our findings. However, it is possible that the progression of DPN symptoms is complex, and other factors may have interfered with these changes throughout the study period. The improvement in DPN symptoms for both groups at 24 weeks compared to baseline might be attributed to improvements in glycemia control, as higher glycemic levels correspond to more severe DPN-related symptoms\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Unfortunately, this study lacked metabolic control over the 24-week period, making it challenging to solely credit the foot-ankle exercises program for the improvement in DPN symptoms.\u003c/p\u003e \u003cp\u003eHigh peak pressures are recognized risk factors for ulcers in individuals with DPN\u003csup\u003e\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Therefore, it is recommended that these plantar loadings\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e be monitored to maintain them within a safe threshold below 200kPa when wearing footwear \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and below 402kPa when barefoot\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. The IG exhibited a mean difference reduction in forefoot peak pressure of 283kPa from baseline to 12 weeks; however, at the 24-week follow-up, there was an increase in forefoot peak pressure compared to both the baseline (128kPa) and the CG (157kPa). Clearly, attention should be paid to keeping plantar pressures below the ulcer risk thresholds, however this modification may be linked to the gain in ankle ROM and plantarflexion during push-off in the IG, manifesting only after 24 weeks of intervention, which is a positive result. The exercises program may have led to an improvement in the foot rollover due to the gain in the ankle motion and shifted more pressure towards the forefoot region. The increase in the forefoot plantar loads after 24 weeks of intervention may suggest a delayed response or long-term adaptation to the program. It is possible that the body underwent an adjustment period before fully demonstrating the program's benefits. It is also worth mentioning that the participants' body weight remained almost unchanged throughout the 24 weeks of the study, suggesting that it had no impact on the plantar pressure distribution.\u003c/p\u003e \u003cp\u003eAt the 24-week follow-up, IG showed an increase in both ankle ROM compared to the 12-week assessment and in plantarflexion at push-off compared to the CG, suggesting a greater ankle contribution in the push-off phase, which potentially changed the foot rollover process. Moderate evidence supports the efficacy of foot-ankle exercises programs in enhancing foot-ankle ROM \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, as confirmed by our findings. Individuals with DPN exhibit limitations in dynamic dorsi and plantarflexion \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e, as well as passive ankle ROM\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e. These motion restrictions can significantly impact the foot rollover pattern during locomotor activities, affecting the load distribution under the foot, as well as balance control. Thus, gaining joint ROM and a pressure redistribution during gait might be seen as a positive outcome. Additionally, CG showed a reduced hip flexor moment at heel strike at 12 weeks, an increased ankle ROM at 12 and 24 weeks, and an increased hip extensor moment at push-off at 24 weeks compared to baseline. These positive outcomes in CG might imply either an effect resulting from usual care received or a placebo effect resulting from professional care and confident patient\u0026ndash;therapist interactions \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, in which mere participation and standard care instructions could yield positive results.\u003c/p\u003e \u003cp\u003eAlthough treatment programs of 8 to 12 weeks are recommended by the IWGDF (2023) \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e prevention guidelines, our findings suggest that the proposed intervention duration (12-week) may not have been sufficient to produce significant changes in the analyzed outcomes. A longer intervention period may be necessary for the beneficial effects to become more evident and consistent, particularly in a web-based program.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study's strengths lie in its rigorous methodological design and the provision of a free, globally accessible web-based exercises program, fostering equity, ubiquity and health awareness for individuals with DPN, which is essential for self-care maintenance. Notably, this is the first studyto test specific foot-ankle exercises conducted through a personalized web-based platform for people with diabetes. However, limitations include the lack of direct supervision hindering control over participants' exercises completion and performance. Closer supervision might have ensured better exercise performance and, consequently, greater clinical, functional, and biomechanical gains. Additionally, the study did not monitor metabolic control, potentially impacting DPN-related outcomes. The COVID-19 posed challenges, leading to higher lost-to-follow-up rates, highlighting the need for innovative web-based interventions in global healthcare systems.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur 12-week web-based foot-ankle therapeutic exercises program (SOPeD) was feasible, acceptable, demonstrating safety with minimal adverse events, and had a very good patient adherence. Improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion during gait were noted, but were modest overall, which might indicate a need for a longer and more intense web-based exercises program to achieve more pronounced outcomes in foot-ankle biomechanics and plantar pressure for individuals with DPN. Given the relatively low cost and high benefits of a web-based ankle-foot therapeutic exercises program, we humbly invite researchers and clinicians to replicate it and we will offer help if needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Professor Ana Claudia Latronico Xavier and the Diabetes Ambulatory activities at Hospital das Cl\u0026iacute;nicas, Faculty of Medicine, University of\u0026nbsp;S\u0026atilde;o Paulo for supporting us with a database of patients with diabetes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have made substantial contributions to all sections of the manuscript, the conception and design of the study, the acquisition of data, and analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be submitted. JSSPF was responsible for the study design, interpretation of the data, writing the report, submission of the manuscript and management. RHCJr is responsible for the study design, data collection, analysis, and interpretation, writing the report and submission of the manuscript. ESQ and RLM are responsible for the study design, data collection, review and editing. ICNS is responsible for the study design, fundings for the study, interpretation of the data, writing the report and submission of the manuscript. JLV, CG and MD contributed to drafting and revising the manuscript. All authors read, provided feedback and approved the final manuscript. No professional writers have been involved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study\u0026nbsp;are accessible as anonymized data on the University\u0026apos;s public repository at https://repositorio.usp.br/.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be considered as a potential conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Sao Paulo Research Foundation [FAPESP 2019/02522-0] and by the National Council for Scientific and Technological Development, Brazil (CNPq) [28/2018 FOCA Trial 407252/2018-5]. Monteiro and Cruvinel were supported by FAPESP [2017/17848-3; 2021/00807-8]; Silva and Verissimo were supported by the Agency Coordination of Improvement of Higher Education Personnel (CAPES, financial Code 001). Sacco is supported as a fellow researcher in CNPq, Brazil (Process 302558/2022-5). The funders had no role in the design, execution, interpretation, or writing of the study and did not have any authority over any study activity or in the decision to submit the report for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePop-Busui, R. \u003cem\u003eet al.\u003c/em\u003e Diabetic neuropathy: A position statement by the American diabetes association. Diabetes Care 40, 136\u0026ndash;154 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGordois, A., Scuffham, P., Shearer, A., Oglesby, A. \u0026amp; Tobian, J. A. The health care costs of diabetic peripheral neuropathy in the US. 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M. \u003cem\u003eRelationship of Limited Joint Mobility to Abnormal Foot Pressures and Diabetic Foot Ulceration\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://diabetesjournals.org/care/article-pdf/14/1/8/440238/14-1-8.pdf\u003c/span\u003e\u003cspan address=\"http://diabetesjournals.org/care/article-pdf/14/1/8/440238/14-1-8.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartinelli, A. R. \u003cem\u003eet al.\u003c/em\u003e Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies. Foot 23, 17\u0026ndash;21 (2013).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Demographics, anthropometrics, and clinical characteristics of the control and intervention groups participants at baseline (n=62).\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52.1 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57.0 \u0026plusmn; 9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass\u003c/strong\u003e (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.8 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e85.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight\u003c/strong\u003e (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e167.0\u0026nbsp;\u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e165.0\u0026nbsp;\u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index\u003c/strong\u003e (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\"\u003e\n \u003cp\u003e28.2 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\"\u003e\n \u003cp\u003e31.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e (Female = n (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e20 (64.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e18 (58.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 2 Diabetes\u003c/strong\u003e (n (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e26 (83.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e30 (96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime of diabetes onset\u003c/strong\u003e (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e15.3 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e10.3 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTactile sensitivity\u0026nbsp;\u003c/strong\u003e(number of areas with loss of protective sensation) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 [0-1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 [0-0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVibration perception\u0026nbsp;\u003c/strong\u003e(n (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eabsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003ereduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003epresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e19 (61.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e20 (64.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecruitment Location\u0026nbsp;\u003c/strong\u003e(n (%))\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;University tertiary hospital - Hospital das Cl\u0026iacute;nicas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e13 (41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Local and regional population campaign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eBrazilian Diabetes Care Association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u0026nbsp;\u003c/strong\u003e(n (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eElementary education incomplete\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (6.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eElementary education complete\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (6.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eHigh school incomplete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (9.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eHigh school complete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (32.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (32.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eHigher education incomplete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (16.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eHigher education complete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (22.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic status (n (%))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eLess than 1 Brazilian minimum salary/ month\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (3.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 to 3 Brazilian minimum salary/ month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e19 (61.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 to 5 Brazilian minimum salary/month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eUp to 5 Brazilian minimum salary/month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDPN symptoms\u003c/strong\u003e (MNSI score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"top\"\u003e\n \u003cp\u003e6.7 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e6.3 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDPN severity\u003c/strong\u003e (Fuzzy score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"top\"\u003e\n \u003cp\u003e3.9 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.7 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eQALY\u003c/strong\u003e (EQ-5D score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"top\"\u003e\n \u003cp\u003e0.6 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.6 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFHSQ\u0026nbsp;\u003c/strong\u003e(score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eFoot pain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e43.1 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eFoot function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e70.2 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e63.0 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eShoes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e55.9 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.70932069510268%\" valign=\"bottom\"\u003e\n \u003cp\u003eFoot Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.436018957345972%\" valign=\"bottom\"\u003e\n \u003cp\u003e25.5 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.85466034755134%\" valign=\"bottom\"\u003e\n \u003cp\u003e24.3 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eData are presented as mean (SD) or as n or %; and median (interquartile range IQR). \u003cstrong\u003eAbbreviation\u003c/strong\u003e: MNSI - Michigan Neuropathy Screening Instrument; FHSQ- Foot Health Status Questionnaire; DPN diabetic peripheral neuropathy; QALY -\u0026nbsp;Quality Adjusted Life Years.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003ePoisson distribution and ordinal logistic models were employed to analyze the variable tactile sensitivity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eEstimated mean \u0026plusmn; standard error (SE) or IQR when applicable, p-values from generalized estimating equation (GEE), and between-group mean differences at 12 and 24 weeks (95% confidence interval) for the DPN-related and functional outcomes in the Intervention Group and Control Group.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"996\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.130260521042084%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.74549098196393%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.74549098196393%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.541082164328657%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween-Group Difference (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.7374749498998%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eGEE Analysis\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(p-values)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.10020040080160321%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Intervention X Control Group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e \u003cstrong\u003e(Intervention X Control Group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup x Time (interaction effect)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDPN symptoms\u0026nbsp;\u003c/strong\u003e(MNSI score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e6.71 \u0026plusmn; 0.34\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5.62 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e4.90 \u0026plusmn; 0.53\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e6.29 \u0026plusmn; 0.27\u003cstrong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5.59 \u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5.29 \u0026plusmn; 0.33\u003cstrong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (-1.33, 1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-0.39 (-1.63, 0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDPN severity\u0026nbsp;\u003c/strong\u003e(Fuzzy score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3.93 \u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3.22 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e2.96 \u0026plusmn; 0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3.66 \u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3.31 \u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3.49 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-0.09 (-1.34, 1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-0.53 (-1.90, 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTactile sensitivity\u0026nbsp;\u003c/strong\u003e(number of areas [median, IQR])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0 [0-1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0 [0-0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0 [0-0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0 [0-0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0 [0-0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0 [0-0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.397\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVibration perception\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eabsent left\u0026nbsp;\u003c/strong\u003e(number of participants)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e9 (29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e2 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVibration perception\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ereduced left\u003c/strong\u003e (number of participants)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e6 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e2 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e2 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVibration perception\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eabsent right\u0026nbsp;\u003c/strong\u003e(number of participants)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e6 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e6 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e1 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e6 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVibration perception\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ereduced right\u003c/strong\u003e (number of participants)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e3 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e2 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e2 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e1 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFHSQ Foot pain\u0026nbsp;\u003c/strong\u003e(score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e46.69 \u0026plusmn; 4.06\u003csup\u003ed,e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e68.09 \u0026plusmn; 5.31\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e71.25 \u0026plusmn; 5.58\u003csup\u003e2,e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e46.09 \u0026plusmn; 4.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e54.94 \u0026plusmn; 5.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e51.06 \u0026plusmn; 6.04\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e13.15 (-1.78,\u0026nbsp;28.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e20.18 (4.04, 36.33)\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFHSQ Foot function\u0026nbsp;\u003c/strong\u003e(score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e70.16 \u0026plusmn; 4.69\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e73.13 \u0026plusmn; 5.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e84.86 \u0026plusmn; 4.46\u003csup\u003e3,c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e63.02 \u0026plusmn; 5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e74.05 \u0026plusmn; 5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e66.40 \u0026plusmn; 5.94\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e2.08 (-13.63,\u0026nbsp;17.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e18.46 (3.88,\u0026nbsp;33.04)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFHSQ Shoes\u0026nbsp;\u003c/strong\u003e(score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e69.33 \u0026plusmn; 5.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e57.89 \u0026plusmn; 7.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e66.15 \u0026plusmn; 7.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e65.90 \u0026plusmn; 6.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e62.49 \u0026plusmn; 6.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e51.58 \u0026plusmn; 5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-4.60(-23.09,\u0026nbsp;13.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e14.56 (-3.90, 33.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFHSQ Foot health\u0026nbsp;\u003c/strong\u003e(score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e34.45 \u0026plusmn; 3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e44.97 \u0026plusmn; 5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e48.38 \u0026plusmn; 5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e32.82 \u0026plusmn; 3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e42.20 \u0026plusmn; 4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e40.31 \u0026plusmn; 5.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e0.77 (-13.00,\u0026nbsp;14.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e8.07 (-7.11, 23.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEQ-5D\u0026nbsp;\u003c/strong\u003e(score, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0.65 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0.63 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0.60 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0.63 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e0.57 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.06,\u0026nbsp;0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e0.05 (-0.04,\u0026nbsp;0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHallux strength\u0026nbsp;\u003c/strong\u003e(%BW, mean\u0026plusmn;SE)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e11.35 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e11.19 \u0026plusmn; 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e11.35 \u0026plusmn; 0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e13.79 \u0026plusmn; 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e13.47 \u0026plusmn; 1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e11.16 \u0026plusmn; 0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-2.28 (-5.17,\u0026nbsp;0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e0.19 (-1.86, 2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eToes strength\u0026nbsp;\u003c/strong\u003e(%BW, mean\u0026plusmn;SE)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e8.28 \u0026plusmn;\u0026nbsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e8.26 \u0026plusmn; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e9.48 \u0026plusmn; 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e8.95 \u0026plusmn; 0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e8.99 \u0026plusmn; 0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e7.84 \u0026plusmn; 1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e-0.73 (-2.80,\u0026nbsp;1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e1.64 (-1.15, 4.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e0.936\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.115115115115115%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional Reach Test\u0026nbsp;\u003c/strong\u003e(cm, mean\u0026plusmn;SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e27.00 \u0026plusmn; 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e29.71 \u0026plusmn; 1.34\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e28.75 \u0026plusmn; 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e24.58 \u0026plusmn;\u0026nbsp;1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e26.36 \u0026plusmn; 1.04\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.607607607607608%\" valign=\"top\"\u003e\n \u003cp\u003e27.44 \u0026plusmn; 1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e3.35 (0.02, 6.68)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.21021021021021%\" valign=\"top\"\u003e\n \u003cp\u003e1.31 (-1.91,\u0026nbsp;4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3043043043043046%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.604604604604605%\" valign=\"top\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.90990990990991%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation:\u003c/strong\u003e MNSI \u0026ndash; Michigan Neuropathy Screening Instrument; FHSQ \u0026ndash; Foot Health Status Questionnaire; BW \u0026ndash; Body Weight\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003egroup effect p=0.046, between-group difference at 12-week (post hoc p=0.049)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003egroup effect p=0.047, between-group difference at 24-week (post hoc p=0.014)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u0026nbsp;\u003c/sup\u003egroup effect p=0.043, between-group difference at 24-week (post hoc p=0.013)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e time effect p\u0026lt;0.001, difference between baseline and 24-week in the intervention group (post hoc p=0.004)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e time effect p\u0026lt;0.001, difference between baseline and 24-week in the control group (post hoc p=0.036)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e time effect p\u0026lt;0.037, difference between baseline and 24-week in the intervention group (post hoc p=0.009)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ed\u0026nbsp;\u003c/sup\u003etime effect p\u0026lt;0.001, difference between baseline and 12-week in the intervention\u0026nbsp;group (post hoc p=0.001)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ee\u003c/sup\u003e time effect p\u0026lt;0.001, difference between 12-week and 24-week in the control group (post hoc p=0.001)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eEstimated mean and SE, p-values from GEE, and between-group mean differences at 12 and 24 weeks (95% confidence interval) for the plantar pressure variables during gait\u003csup\u003e\u0026nbsp;\u003c/sup\u003ein the Intervention Group and Control Group.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1032\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.69767441860465%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.286821705426355%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.414728682170544%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.934108527131784%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween-Group Difference (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.988372093023257%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eGEE Analysis (p-values)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.6782945736434108%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.2984496124031%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion of Interest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.39922480620155%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.170542635658915%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.817829457364342%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.461240310077519%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.531007751937985%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Intervention X Control Group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.4031007751938%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Intervention X Control Group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3604651162790695%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.263565891472868%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.364341085271318%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup x Time (interaction effect)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.2984496124031%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eHindfoot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.39922480620155%\"\u003e\n \u003cp\u003e\u003cstrong\u003eContact Area\u0026nbsp;\u003c/strong\u003e[cm\u003csup\u003e2\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.170542635658915%\"\u003e\n \u003cp\u003e34.1\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e34.9\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.817829457364342%\" colspan=\"2\"\u003e\n \u003cp\u003e35.4\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e35.1\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e35.6\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.461240310077519%\" colspan=\"2\"\u003e\n \u003cp\u003e35.8\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.531007751937985%\"\u003e\n \u003cp\u003e-0.7 (-2.9, 1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.4031007751938%\" colspan=\"2\"\u003e\n \u003cp\u003e-0.4 (-2.7, 1.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3604651162790695%\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.263565891472868%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.364341085271318%\" colspan=\"2\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeak Pressure\u003c/strong\u003e[kPa]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e355.3\u0026plusmn;14.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e365.1\u0026plusmn; 20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e386.4\u0026plusmn;35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e343.3\u0026plusmn;11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e349.3\u0026plusmn;14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e350.8\u0026plusmn;14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e15.8 (-33.4, 65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e35.6 (-21.6, 92.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure-time integral\u0026nbsp;\u003c/strong\u003e[(kPa)*s]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e104.3\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e104.1\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e107.6\u0026plusmn;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e106.7\u0026plusmn;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e100.0\u0026plusmn;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e107.7\u0026plusmn;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e4.1 (-9.4, 17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e-0.1 (-15.5, 15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.2984496124031%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidfoot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.39922480620155%\"\u003e\n \u003cp\u003e\u003cstrong\u003eContact Area\u0026nbsp;\u003c/strong\u003e[cm\u003csup\u003e2\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.170542635658915%\"\u003e\n \u003cp\u003e29.0\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e29.9\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.817829457364342%\" colspan=\"2\"\u003e\n \u003cp\u003e27.9\u0026plusmn;2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e31.0\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e31.3\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.461240310077519%\" colspan=\"2\"\u003e\n \u003cp\u003e32.5\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.531007751937985%\"\u003e\n \u003cp\u003e-1.4 (-5.7, 2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.4031007751938%\" colspan=\"2\"\u003e\n \u003cp\u003e-4.7 (-9.6, 0.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3604651162790695%\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.263565891472868%\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.364341085271318%\" colspan=\"2\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeak Pressure\u003c/strong\u003e[kPa]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e184.7\u0026plusmn;12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e176.4\u0026plusmn;12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e175.0\u0026plusmn;14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e194.2\u0026plusmn;8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e191.0\u0026plusmn;12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e204.1\u0026plusmn;13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e-14.6 (-48.9, 19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e-29.1 (-69.0, 10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure-time integral\u0026nbsp;\u003c/strong\u003e[(kPa)*s]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e70.6\u0026plusmn;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e63.1\u0026plusmn;5.67\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e71.9\u0026plusmn;9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e84.4\u0026plusmn;5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e81.6\u0026plusmn;6.9\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e86.5\u0026plusmn;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e-18.5 (-36.0, -1.0)\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e-14.6 (-37.2, 8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.2984496124031%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eForefoot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.39922480620155%\"\u003e\n \u003cp\u003e\u003cstrong\u003eContact Area\u0026nbsp;\u003c/strong\u003e[cm\u003csup\u003e2\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.170542635658915%\"\u003e\n \u003cp\u003e51.6\u0026plusmn;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e665.5\u0026plusmn;51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.817829457364342%\" colspan=\"2\"\u003e\n \u003cp\u003e53.2\u0026plusmn;\u0026nbsp;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e53.0\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e53.9\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.461240310077519%\" colspan=\"2\"\u003e\n \u003cp\u003e54.2\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.531007751937985%\"\u003e\n \u003cp\u003e-0.3 (-3.9, 3.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.4031007751938%\" colspan=\"2\"\u003e\n \u003cp\u003e-0.99 (-5.3, 3.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3604651162790695%\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.263565891472868%\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.364341085271318%\" colspan=\"2\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeak Pressure\u003c/strong\u003e[kPa]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e586.7\u0026plusmn; 37.6\u003cstrong\u003e\u003csup\u003ea,b\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e303.6\u0026plusmn; 64.5\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e715.0\u0026plusmn;61.7\u003cstrong\u003e\u003csup\u003e2,b\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e561.3\u0026plusmn;30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e594.4\u0026plusmn;33.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e557.8\u0026plusmn; 30.4\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e71.0 (-49.0, 191.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e157.2 (22.4, 292.1)\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure-time integral\u0026nbsp;\u003c/strong\u003e[(kPa)*s]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e199.9\u0026plusmn;13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e217.7\u0026plusmn;17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e251.8\u0026plusmn;22.1\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e203.8\u0026plusmn;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e202.7\u0026plusmn;11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e195.2\u0026plusmn;9.3\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e15.0 (-26.8, 56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e56.6 (9.7, 103.5)\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.2984496124031%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eHallux\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.39922480620155%\"\u003e\n \u003cp\u003e\u003cstrong\u003eContact Area\u0026nbsp;\u003c/strong\u003e[cm\u003csup\u003e2\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.170542635658915%\"\u003e\n \u003cp\u003e10.3\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e10.4\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.817829457364342%\" colspan=\"2\"\u003e\n \u003cp\u003e10.3\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e11.0\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e11.1\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.461240310077519%\" colspan=\"2\"\u003e\n \u003cp\u003e11.0\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.531007751937985%\"\u003e\n \u003cp\u003e-0.7 (-1.7, 0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.4031007751938%\" colspan=\"2\"\u003e\n \u003cp\u003e-0.7 (-1.7, 0.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3604651162790695%\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.263565891472868%\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.364341085271318%\" colspan=\"2\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeak Pressure\u003c/strong\u003e[kPa]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e391.6\u0026plusmn; 33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e457.4\u0026plusmn; 54.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e428.0\u0026plusmn;62.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e440.9\u0026plusmn;41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e403.9\u0026plusmn;40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e401.7\u0026plusmn; 57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e53.5 (-79.3, 186.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e26.3 (-139.3, 191.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure-time integral\u0026nbsp;\u003c/strong\u003e[(kPa)*s]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e97.6\u0026plusmn;11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e106.4\u0026plusmn;16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e100.3\u0026plusmn;19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e111.7\u0026plusmn;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e95.3\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e97.8\u0026plusmn;13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e11.0 (-25.6, 47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e2.5 (-43.2, 48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.2984496124031%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eToes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.39922480620155%\"\u003e\n \u003cp\u003e\u003cstrong\u003eContact Area\u0026nbsp;\u003c/strong\u003e[cm\u003csup\u003e2\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.170542635658915%\"\u003e\n \u003cp\u003e9.5\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e9.7\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.817829457364342%\" colspan=\"2\"\u003e\n \u003cp\u003e10.2\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e10.3\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e9.8\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.461240310077519%\" colspan=\"2\"\u003e\n \u003cp\u003e10.7\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.531007751937985%\"\u003e\n \u003cp\u003e-0.1 (-2.0, 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.4031007751938%\" colspan=\"2\"\u003e\n \u003cp\u003e-0.5 (-2.7, 1.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.3604651162790695%\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.263565891472868%\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.364341085271318%\" colspan=\"2\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeak Pressure\u003c/strong\u003e[kPa]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e172.5\u0026plusmn;15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e177.3\u0026plusmn;22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e204.1\u0026plusmn;32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e199.6\u0026plusmn;21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e175.3\u0026plusmn;27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e206.1\u0026plusmn;36.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e1.9 (-68.4, 72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e-2.0 (96.9, 93.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.037\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.031023784901757%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePressure-time integral\u0026nbsp;\u003c/strong\u003e[(kPa)*s]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.652533609100311%\"\u003e\n \u003cp\u003e47.1\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e44.2\u0026plusmn;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.410548086866598%\" colspan=\"2\"\u003e\n \u003cp\u003e50.2\u0026plusmn;6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e61.9\u0026plusmn;8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.445708376421924%\"\u003e\n \u003cp\u003e49.1\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.96277145811789%\" colspan=\"2\"\u003e\n \u003cp\u003e59.4\u0026plusmn;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.306101344364013%\"\u003e\n \u003cp\u003e-5.0 (-23.6, 13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.236814891416753%\" colspan=\"2\"\u003e\n \u003cp\u003e-9.2 (-34.7, 16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.653567735263702%\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.550155118924509%\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.859358841778697%\" colspan=\"2\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003egroup effect p=0.047, between-group difference at 12-week (post hoc p=0.038)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003egroup effect p=0.049, between-group difference at 24-week (post hoc p=0.022)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u0026nbsp;\u003c/sup\u003einteraction effect p=0.008,\u003csup\u003e\u0026nbsp;\u003c/sup\u003egroup effect p=0.208, between-group difference at 24-week (post hoc p=0.018)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003etime effect p\u0026lt;0.027, difference between baseline and 12-week in the intervention group (post hoc p=0.044)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003eb\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003etime effect p\u0026lt;0.027, difference between baseline and 24-week in the intervention group (post hoc p=0.026)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eEstimated mean and SE, p-values from GEE, and between-group mean difference at 12 and 24 weeks (95% confidence interval) for the hip, knee, and foot-ankle kinematics and hip, knee, and ankle joint kinetics during gait in the Intervention Group and Control Group at baseline and follow-up assessments.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"999\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.71771771771772%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.62162162162162%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.123123123123122%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group (n=31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.71971971971972%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween-Group Difference (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.81781781781782%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eGEE Analysis (p-values)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated mean (SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(Intervention X Control Group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(Intervention X Control Group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup x Time (interaction effect)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eANKLE kinematics and kinetics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eAnkle ROM (degree)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e24.52 \u0026plusmn; 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e23.49 \u0026plusmn; 0.89\u003cstrong\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e26.41 \u0026plusmn; 1.07\u003cstrong\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e23.74 \u0026plusmn; 0.55\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e23.88 \u0026plusmn; 0.60\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e25.56 \u0026plusmn; 0.66\u003csup\u003ed,e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e-0.38\u0026nbsp;(-2.50, 1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.85 (-1.62, 3.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eAnkle dorsiflexion at heel strike (degree)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e3.90 \u0026plusmn; 0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e3.04 \u0026plusmn; 0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.78 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e3.13 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e4.25 \u0026plusmn; 1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e4.81 \u0026plusmn; 0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e-1.20 (-3.58, 1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-2.03 (-3.89, -0.16)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eAnkle plantarflexion at push off (degree) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.00 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.50 \u0026plusmn; 1.17\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e5.12 \u0026plusmn; 0.01\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e4.49 \u0026plusmn; 0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e2.78 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e2.30 \u0026plusmn; 0.71\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ndash;0.27 (-2.70,\u0026nbsp;2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.82 (1.42, 4.22)\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eAnkle flexor moment at heel strike (Nm/(BM*Height)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u0026plusmn;0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.021\u0026plusmn;0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u0026plusmn;0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e0.013\u0026plusmn;0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.016\u0026plusmn;0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.022\u0026plusmn;0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e0.004 (-0.019, 0.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.008 (-0.024, 0.007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eAnkle extensor moment at push off (Nm/(BM* Height)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e1.32 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e1.39 \u0026plusmn; 0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e1.38 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e1.31 \u0026plusmn; 0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e1.27 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e1.36 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (-0.1, 0.27)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.07, 0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eAnkle peak eccentric power at the push off (W/BM*Height)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.21 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.53 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e2.42 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e2.50 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e2.50 \u0026plusmn; 0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e2.54 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (-0.45, 0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.11 (-0.47, 0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOXFORD FOOT MODEL kinematics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eHindfoot to tibia ROM (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e23.22 \u0026plusmn; 1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e23.99 \u0026plusmn; 1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e24.15 \u0026plusmn; 1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e22.63 \u0026plusmn; 0.92\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e24.86 \u0026plusmn; 1.05\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e25.89 \u0026plusmn; 1.07\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e-0.86 (-4.29, 2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-1.73 (-6.10, 2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eHindfoot to tibia peak angle (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e13.74 \u0026plusmn; 1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e15.95 \u0026plusmn; 2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e11.65 \u0026plusmn; 1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e13.38 \u0026plusmn; 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e14.86 \u0026plusmn; 1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e14.91 \u0026plusmn; 1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e1.08 (-3.55, 5.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-3.25 (-6.68, 0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eForefoot to hindfoot ROM (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e13.16 \u0026plusmn; 0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e13.69 \u0026plusmn; 1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e13.41 \u0026plusmn; 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e12.54 \u0026plusmn; 0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e12.63 \u0026plusmn; 1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e12.34 \u0026plusmn; 0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e1.06 (-2.47, 4.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.06 (-0.98, 3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eForefoot to hindfoot peak angle (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e8.34 \u0026plusmn; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e6.99\u0026nbsp;\u0026plusmn; 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e6.70 \u0026plusmn; 0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e7.88 \u0026plusmn; 0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e7.61 \u0026plusmn; 0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e6.65 \u0026plusmn; 0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e-0.61 (-3.33, 2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.04 (-2.53, 2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eHallux to forefoot ROM (degree)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e24.56 \u0026plusmn; 1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e25.56 \u0026plusmn; 2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e24.86 \u0026plusmn; 1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e21.61 \u0026plusmn; 1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e23.70 \u0026plusmn; 1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e22.65 \u0026plusmn; 1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e1.85 (-3.12, 6.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.20 (-1.90, 6.32)\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eHallux to forefoot peak angle (degree)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e23.96 \u0026plusmn; 1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e26.31 \u0026plusmn; 2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e25.09 \u0026plusmn; 1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e21.96 \u0026plusmn; 1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e22.10 \u0026plusmn; 1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e21.32 \u0026plusmn; 1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e4.21 (-1.70, 10.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e3.77 (-1.25, 8.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eMaximum arch height (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e11.30 \u0026plusmn; 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e10.50 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e10.60 \u0026plusmn; 0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e11.67 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e11.61 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e10.78 \u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e-1.10 (-2.18, -0.02)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.17 (-1.53, 1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eMinimum arch height (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e8.90 \u0026plusmn; 0.29\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e8.13 \u0026plusmn; 0.33\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e8.07 \u0026plusmn; 0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e9.28 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e9.17 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e8.51 \u0026plusmn; 0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e-1.04 (-2.14, 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.44 (-1.72, 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIP and KNEE Kinetics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eHip flexor moment at heel strike (Nm/(BM*Height)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 \u0026plusmn; 0.05\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.72 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 \u0026plusmn; 0.18*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.30 \u0026plusmn; 0.15*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.60 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e0.28 (-0.16, 0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (-0.55, 0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eHip extensor moment at push off (Nm/(BM* Height)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.07 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e0.06 \u0026plusmn; 0.01\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.06 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.17 \u0026plusmn; 0.03\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.08, 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.03 (-0.14, 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.7%\" valign=\"top\"\u003e\n \u003cp\u003eKnee extensor moment at push off (Nm/(BM* Height)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.11 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 \u0026plusmn; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.03, 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.4%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.01 (-0.05, 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7%\" valign=\"top\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6%\" valign=\"top\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation:\u003c/strong\u003e BM \u0026ndash; Body Mass, ROM \u0026ndash; Range Of Motion\u003c/p\u003e\n\u003cp\u003e*\u003csup\u003e\u0026nbsp;\u003c/sup\u003einteraction effect p=0.001, time-difference between baseline and 12-week in the control group (post hoc p=0.003); \u0026nbsp;\u003csup\u003ea\u003c/sup\u003e time effect p=0.001, time-difference between baseline and 24-week in the control group (post hoc p=0.001); \u0026nbsp;\u003csup\u003eb\u0026nbsp;\u003c/sup\u003egroup effect p=0.037, between-group difference at 24-week (post hoc p=0.029); \u0026nbsp;\u003csup\u003ec\u0026nbsp;\u003c/sup\u003etime effect p=0.001, difference between12-week and 24-week in the intervention group (post hoc p=0.018); \u0026nbsp;\u003csup\u003ed\u003c/sup\u003e time effect p=0.001, difference between 12-week and 24-week in the control group (post hoc p=0.023); \u0026nbsp;\u003csup\u003ee\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003etime effect p=0.001, difference between baseline and 24-week in the control group (post hoc p=0.043); \u0026nbsp;\u003csup\u003e1\u0026nbsp;\u003c/sup\u003egroup effect p=0.038, between-group difference at 24-week (post hoc p=0.001); \u0026nbsp;\u003csup\u003eg\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003etime effect p=0.047, difference between baseline and 12-week in the intervention group (post hoc p=0.029)\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diabetic neuropathies, exercise therapy, foot-related exercises, eHealth, rehabilitation technology, biomechanics","lastPublishedDoi":"10.21203/rs.3.rs-4413701/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4413701/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe need for strategies to prevent complications arising from diabetic neuropathy (DPN) is well recognized, yet foot-ankle exercises programs present weak to moderate evidence and barriers persist in their implementation, including the democratization of access to exercise programs. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercises program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG;n=31), which received the usual care, or the intervention group (IG;n=31), which received the usual care plus a 12-week foot-ankle exercises program using a web-based software (the SOPeD software). Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program; however, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion during push-off at 24 weeks. Regarding plantar loadings during gait, there was a forefoot pressure reduction at 12 weeks compared to baseline, but at 24 weeks, forefoot loads increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion during gait were noted, mostly at 24 weeks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration:\u003c/strong\u003e ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.\u003c/p\u003e","manuscriptTitle":"Effectiveness of a web-based foot-ankle exercises program for treating modifiable risk factors for ulcers in people with diabetic neuropathy: a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:35:19","doi":"10.21203/rs.3.rs-4413701/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-12T04:10:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-25T18:02:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-15T20:02:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112755290569915054859220922640041814191","date":"2024-06-10T19:39:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249803075565674757359521598106702792831","date":"2024-06-06T19:45:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-06T18:39:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-06T18:32:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-27T04:20:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-27T04:11:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-13T13:58:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ed8bf31-c5ac-436a-82e7-9edd63710a14","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":32926015,"name":"Health sciences/Diseases/Neurological disorders/Peripheral neuropathies"},{"id":32926016,"name":"Health sciences/Endocrinology/Endocrine system and metabolic diseases/Diabetes/Diabetes complications"},{"id":32926017,"name":"Health sciences/Health care/Therapeutics/Rehabilitation"}],"tags":[],"updatedAt":"2024-11-11T16:08:56+00:00","versionOfRecord":{"articleIdentity":"rs-4413701","link":"https://doi.org/10.1038/s41598-024-78188-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-11-08 15:58:16","publishedOnDateReadable":"November 8th, 2024"},"versionCreatedAt":"2024-06-11 18:35:19","video":"","vorDoi":"10.1038/s41598-024-78188-7","vorDoiUrl":"https://doi.org/10.1038/s41598-024-78188-7","workflowStages":[]},"version":"v1","identity":"rs-4413701","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4413701","identity":"rs-4413701","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}