Article review

Title article : Early-Stage Diabetic Neuropathy Reduces Foot Strength and

Intrinsic but Not Extrinsic Foot Muscle Size

Author : Adrienne D. Henderson , A. Wayne Johnson , Lindsey G.

Rasmussen, Weston P. Peine, Sydney H. Symons, Kade A.
Scoresby, Sarah T. Ridge , and Dustin A. Bruening

Published : Received 26 November 2019; Revised 14 February 2020;

Accepted 25 February 2020; Published 12 March 2020, Exercise
Sciences Department, Brigham Young University, Provo, UT,
USA, Correspondence should be addressed to Adrienne D.
Henderson; adriennedhenderson@gmail.com

Assignment Subject of Research

Under Supervised of

Dr. Abdul Muhit, S. Kep.,Ns.,M.Kes

Student Name:

Leili Setiawan Rosyid

NIM. 2052B1010

Post Graduate Study

Institut Ilmu Kesehatan Strada Indonesia

Kediri, Indonesia 2020

Title Article : Early-Stage Diabetic Neuropathy Reduces Foot Strength and

 Intrinsic but Not Extrinsic Foot Muscle Size

Author : Adrienne D. Henderson, A. Wayne Johnson, Lindsey G.

Rasmussen, Weston P. Peine, Sydney H. Symons, Kade A.
Scoresby, Sarah T. Ridge, and Dustin A. Bruening

Published : Received 26 November 2019; Revised 14 February 2020;

Accepted 25 Department, Brigham Young University, Provo, UT,
USA.

Background : 1. Tracking progression of diabetic peripheral polyneuropathy

(DPN) is usually focused on sensory nerves and subjective
testing methods.
2. Recent studies have suggested that distal muscle atrophy may
precede sensation loss. Methods to objectively measure distal
muscle size and strength are needed to help understand how
neuropathy affects muscle function.

Research Question : What is the effect of diabetic peripheral polyneuropathy (DPN)

on all three types of nerves: autonomic, sensory, and motor ?

Purpose : To evaluate individual intrinsic and extrinsic foot muscle sizes

and functional foot strength in participants with DPN.

Type of study : Experiment Functional strength of the foot was also measured
using the custom great toe test and lateral toeflection along with
the doming test. Muscle size and strength metrics were compared
between groups using ANOVA and paired t-test (α = 0:05).

Population : Thirty individuals participated in this cross-sectional study (15

DPN and 15 matched controls).

Sample size : Data from 15 male participants diagnosed with diabetes mellitus
and neuropathy and 15 matched healthy male controls (CON)
DPN participants were screened for and excluded if they had a
history of ulcers, amputation, and any neurological condition
 besides DPN or could not walk unassisted. CON participants
were age-, gender-, and height-matched to the DPN participants.
The exclusion criteria for CON included a history of diabetes, any
type of peripheral neuropathy, or any lower extremity injury in
the past 6 months. All participants were volunteers recruited from
the local community and signed consent forms approved by the
local ethics board. Each participant’s height, weight, and age were
recorded, after which the pres- ence of DPN was confirmed using
the Michigan Neuropathy Screening Instrument (MNSI).

Type test : The functional strength of the foot was also measured using the
custom great toe test and lateral to reflection along with the
doming test. Muscle size and strength metrics were compared
between groups using ANOVA and paired t-test (α = 0:05).

Result : Functional foot strength comparisons between DPN and CON

(mean ± SD). Doming (DOM), great toe flexion (GTF), and
lateral toe flexion (LTF) were expressed in raw units (N) as well
as normalized to body mass.

DPN CON p
value
DOM (%BW) 8:96 ± 5:81 11:72 ± 6:80 0.241
DOM (N) 82:03 ± 99:34 ± 49:66 0.887
38:00
GTF (%BW) 5:95 ± 3:95 9:00 ± 3:46 0.032∗
GTF (N) 57:84 ± 80:09 ± 28:45 0.058
36:22
LTF (%BW) 2:87 ± 1:92 6:14 ± 3:76 0.006∗
LTF (N) 27:36 ± 16:61 53:55 ± 29:14 0.012∗

Conclusion : 1. By measuring the cross-sectional area of the leg and lower leg
muscles, we can see decreased size in all intrinsic leg muscles
(QP, AH, FDB, and FHB) but only one extrinsic muscle
(EDL), suggesting that DPN primarily affects the intrinsic
muscles before extrinsic muscles.
2. The GTF and LTF pressure mat strength tests showed
differences between groups and associated specific intrinsic
muscle size. This test appears to isolate the intrinsic leg
muscles from the extrinsic ones and shows potential as a
practical clinical tool for monitoring DPN progression.