Exercise and the diabetic foot

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More evidence that specific , targeted exercise of the foot , can improve foot health , and that this can lead to improved general health .

Hand and foot exercises for diabetic peripheral neuropathy: A randomized controlled trial

Mi Mi Thet Mon Win MNSc
Kiyoko Fukai PhD

Htwe Htwe Nyunt MNSc

Khaing Zaw Linn BNSc
First published: 26 December 2019
https://doi.org/10.1111/nhs.12676



Abstract

Exercises for diabetic peripheral neuropathy remain controversial, especially with regard to recommended precautions and weightbearing exercises for individuals. We aimed to investigate the effect of 8 weeks of simple hand, finger, and foot exercises in patients with diabetic peripheral neuropathy. After randomization, exercise (n = 51) and control (n = 53) groups received usual care and diabetic foot care education; only the exercise group performed exercises. Primary outcomes, including activities of daily living (assessed using the Patient Neurotoxicity Questionnaire), neuropathy severity (monofilament and vibration test), and pain (behavioral rating scale and Visual Analog Scale), and secondary outcomes, including physical function of the hand and foot (grip, pinch, finger counting time, and Timed Up and Go tests), were assessed at baseline, after the 8‐week intervention, and at the 16‐week follow‐up. The exercise group showed significantly stronger improvements in motor score and specific activities of daily living, such as climbing stairs and performing work or chores. Our exercises can be used to improve limb function in patients with diabetic neuropathy.

 

Weak evidence suggests that encouraging blood flow into the foot ,using foot exercises , can promote healing of diabetic foot ulcers . In my opinion , the evidence is weak because few have gone looking .

Question . If reduced blood flow can lead to cell death and even gangrene , why on earth are prescribed foot exercises , which increase blood flow into the foot , not a front line treatment option for diabetic foot ulcers , since tissue health and repair are so obviously linked to a good blood supply ?

 

From abstract of paper below ; In conclusion, the research results are diabetic foot exercise has effect on distal sensory and peripheral neuropathy.

Weak evidence becoming moderate ?

10.5958/0973-9130.2019.00570.X
The Effects of Foot Exercise to Distal Sensorimotor on Diabetic Peripheral Neuropathy
Awaluddin Sri Wahyuni1,*, Ardi Muhammad1, Zabitha Ridzka Ayyanun1
uni.awal@gmail.com, Address: Campus of Department of Nursing, Health Polytechnic of Makassar, South Sulawesi, Indonesia
Online published on 27 November, 2019.
Abstract
Diabetic peripheral neuropathy is one of the complications arising from diabetes mellitus which decreases the function of distal sensory nerve, especially the lower extremity in progressively, and autonomic nerves which could be acute or chronic. This research aimed to determine the effect of diabetic foot gymnastic on distal sensorimotor on people with diabetes with peripheral neuropathy at Jongaya Public Health Center, Tamalate Sub-District, Makassar City. The research method was quasi experiment research design with pretest-posttest research design with control group design. The sample was selected by using purposive sampling. The research results show that foot exercise has effect on sensory sensations (p-value=0.000). There was no effect of diabetic foot exercise on motor sensations (p-value=0.218). Foot exercise has effect on diabetic peripheral neuropathy (p-value=0.005). In conclusion, the research results are diabetic foot exercise has effect on distal sensory and peripheral neuropathy.

 

Still on the same theme , here (below ) , is the conclusion of a paper published in 2017 .

Looking at the three papers I have mentioned in this thread , one thing jumps out . All the studies involved researchers drawn from the nursing profession .

Could researchers drawn from this previously , relatively underutilized "bank of brains" , have a tendency towards "research with its head screwed on" ?


CONCLUSION:

The ulcer areas decreased significantly in the study intervention group compared to the control group during the 3 follow-up measurements. An important finding in this study was the DFU area decreased more in those who exercised more. Findings suggests foot exercises should be included in the treatment plan when managing patients with diabetic foot ulcers.

Paper
The Effect of Foot Exercises on Wound Healing in Type 2 ...


https://www.ncbi.nlm.nih.gov › pubmed
by Ş Eraydin - ‎2017 - ‎Cited by 9 - ‎Related articles19 Dec 2017 - The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer. Eraydin Ş(1), Avşar G. Author information

 

No research going on in the UK ,that I can find, re targeted foot exercise for diabetic feet ( I have made enquiries ) . I believe a change in mindset can only come about with more high quality evidence which means doing the research . IMO, enough there now to warrant better studies .


NEW

Effect of Foot-Ankle Flexibility and Resistance Exercise in the Secondary Prevention of Plantar Foot Diabetic Ulcer
MariaSuryani et al
Journal of Diabetes and its Complications; 28 May 2021, 107968

Highlights
•Recurrence rate of plantar foot diabetic ulcer is very high
•Foot-ankle flexibility and resistance exercise can prevent plantar foot diabetic foot ulcer
•Walking speed and diabetic neuropathy can be improved by foot flexibility and resistance exercise
Aims
The study aimed to evaluate the effects of foot-ankle flexibility and resistance exercises on the recurrence rate of plantar foot diabetic ulcers, HbA1c levels, diabetic neuropathy examination (DNE) scores, ankle brachial index (ABI), and walking speed within 12 and 24 weeks.

Methods
We conducted a double-blind randomized clinical trial. Fifty patients with recently healed plantar foot diabetic ulcers were randomized to an intervention group that performed foot-ankle flexibility and resistance exercise three times a week in their home (n =25) or a control group (n=25). Both groups were given foot care education. Outcomes were assessed at plantar foot diabetic ulcer recurrence or at 12 and 24 weeks whichever came first. Outcome measures included plantar foot diabetic ulcer recurrence, changes of HbA1c levels, DNE scores, ankle brachial index ABI, and walking speed.


Conclusions
Foot-ankle flexibility and resistance exercises can reduce the recurrence of plantar foot diabetic ulcer incidence and improve diabetic neuropathy and walking speed.
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