Future directions
equinus, ankle disability, diabetes and neuropathy
ULCERATION, STRETCHES
There is an absence of existing evidence investigating the effect of mobilisations in people with diabetes and neuropathy. Whilst the result of this study suggests that mobilisations may hold potential for increasing static ankle and first MTPJ ROM, no functional or objective clinical benefits were established. Further randomised control trials are therefore needed to evaluate the effect of mobilisations and stretches on people with diabetes and neuropathy. This is in line with recent recommendations made by a systematic review which advocated the use of foot and ankle exercise programmes but suggested further focus on the effects of specific components of these programmes [Future research is needed to address issues on study design and implementation. Firstly, the inclusion criteria need to be refined to confirm LJMS and the presence of a functional ankle equinus. Secondly, a factorial study design might be more appropriate to separate the effectiveness between mobilisations and stretches. In future trials, more attention is needed to describe the characteristics of care provided to participants in the control group and to those of the intervention group and whether usual care varied between groups which can be viewed as a potential confounder [In addition, the choice of outcome measures (OMs) need to be re-evaluated and consideration needs to be given to OMs that are more meaningful to participants such as using patient-reported outcome measures (foot and ankle disability index, EQ5DL) and clinical outcome measures of foot health including incidence of ulceration. Lastly, the exploring the acceptability and feasibility of delivering the intervention will also be an important component of a future study.