Buerger's Exercise for the Peripheral Circulation of the Diabetic Foot

NewsBot · Jul 19, 2017

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Quantitative Evaluation of Rehabilitation Effect on Peripheral Circulation of Diabetic Foot.
Huang YK, Chang CC, Lin PX, Lin BS.
IEEE J Biomed Health Inform. 2017 Jul 13. doi: 10.1109/JBHI.2017.2726540.

Diabetics may encounter different foot problems, which easily lead to infection, ulcers, and increased risk of amputation due to nerve or vascular injury. In order to reduce the risk of amputation, Buerger's exercise is one of the frequently used rehabilitation to improve the blood circulation in the lower limbs. However, it is difficult to evaluate the rehabilitation efficiency of Buerger's exercise objectively. In this study, a novel non-invasively optical system was developed to non-invasively monitor the change of the foot blood circulation before and after long-term Buerger's exercise. Radial basis function neural network was also used to classify the healthy and diabetic groups from the change of the relative total hemoglobin (HbT) concentration and tissue oxygen saturation (StO2), and provide an index to evaluate the rehabilitation efficiency of Buerger's exercise. Finally, the experimental results showed the relative HbT concentration and StO2 in the lower limbs corresponding to different groups were significantly different, and could be used as the factors for classification of healthy subject and diabetic foot patients. Moreover, the tendency of the relative HbT concentration and StO2 raised after long-term rehabilitation of Buerger's exercise.
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NewsBot · Jan 9, 2018

The assessment of Buerger's exercise on dorsal foot skin circulation in patients with vasculopathic diabetic foot ulcer by using wireless near-infrared spectroscope: a cohort prospective study.
Lin BS et al
Lasers Med Sci. 2018 Jan 8. doi: 10.1007/s10103-017-2420-6.

The improvement of peripheral circulation is crucial for the care of vasculopathic diabetic foot ulcer (DFU). Near-infrared spectroscopy (NIRS) was used to investigate the effects of Buerger's exercise on dorsal foot skin circulation with novel technique of measuring the absorption difference in wavelength of light between oxy-hemoglobin (HbO2) and deoxy-hemoglobin (HbR). Patients with vasculopathic DFU who could tolerate Buerger's exercise three times a day at home for at least 8 weeks were enrolled (group A). They were divided into two subgroups: without previous percutaneous transluminal angioplasty (PTA) (group A1) vs. with previous PTA (group A2). Wireless NIRS were applied on patients' dorsal foot to assess the peripheral circulation in follow-up clinics. The patients' wound condition, follow-up time, and concentration of HbO2 and total hemoglobin (HbT) before and after exercise rehabilitation program were documented. From May 2015 to February 2016, 14 patients with average age of 70.2 ± 11.2 were enrolled in this study (group A), including eight without previous PTA (group A1), and six with previous PTA (group A2). The concentration of HbO2 and HbT were significantly increased after exercise rehabilitation program training in group A (p = 0.024 in HbO2, p = 0.02 in HbT, n = 14) and group A2 (p = 0.021 in HbO2, p = 0.028 in HbT, n = 6), while the concentration in group A1 were improved with borderline significance after exercise (p = 0.055 in HbO2, p = 0.058 in HbT, n = 8). The majority of the ulcers were either completely healed (11/14 = 78.57%) or improving (3/14 = 21.43%). Buerger's exercise improved the peripheral circulation and wound condition in patients with vasculopathic DFU. The wireless apparatus is a novel and efficient tool to monitor rehabilitation program.
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NewsBot · Jan 28, 2022

Effect of buerger allen exercise on foot perfusion among patient with diabetes mellitus: A systematic review & meta-analysis
Ankita Thakur et al
Diabetes Metab Syndr. 2022 Jan 13;16(2):102393

Aim: Buerger-Allen exercise includes set of activities like elevation, movement and rest of the lower extremities. This systematic review and meta-analysis aimed to assess the effectiveness of BAE on foot perfusion among patient with diabetes mellitus.

Material & methods: Five databases were searched for literatures published from inception to October 2020. Cochrane Collaboration Tool for RCTs and ROBINS-I tool for quasi-experimental studies were used for quality assessment.

Results: Four RCTs and six quasi-experimental studies were included, and pooled analysis have shown that the BAE was significantly effective in the improvement of ABI scores (MD = 0.14; 95% CI 0.08-0.19; I2 = 30%; p < 0.000).

Conclusions: Studies showed that BAE effectively improves foot perfusion among patients with diabetes mellitus.
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NewsBot · Jan 12, 2024

The Effect of Modified Buerger-Allen Exercises on Lower Extremities Edema in Late Pregnancy: Randomized Clinical Trial
Fatemeh Mollaelahi, Shadab Shahali
J Obstet Gynaecol India. 2023 Dec;73(6):488-495

Background: Lower limbs edema is one of the common problems in late pregnancy. This study aimed to determine the effect of modified Berger-Allen exercises on lower limb swelling in late pregnancy.

Materials and methods: This randomized clinical trial was conducted on 105 pregnant women suffering from lower limbs edema. Samples were randomly placed in three groups: modified Buerger-Allen exercises for five days, modified Buerger-Allen exercises for ten days, and the control group. Foot circumferences and volume and pain were measured before and after the study.

Results: There was a significant difference between the average of right and left ankle circumference, right and left heel circumference, right and left foot circumference, left foot volume and pain score after the 5-day intervention group (p < 0.05). In the 10-day intervention group, there was a significant difference in all averages of ankles, heels, foot circumference and volume, and pain score 10 days after the intervention, compared to before the intervention (p < 0.05).

Conclusion: Performing innovative modified Buerger-Allen exercises in pregnant women with lower limbs edema may reduce their pain and swelling. It can also reduce the leg areas in pregnant women with lower limb edema in late pregnancy.
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NewsBot · Apr 11, 2024

Effect of Buerger-Allen exercise on wound healing in patients with diabetic foot ulcers: a randomised controlled trial
Ahmad Mahdi Ahmad et al
J Wound Care. 2024 Apr 2;33

Objective: A diabetic foot ulcer (DFU) is a complication of type 2 diabetes that is difficult to treat. Buerger-Allen exercise has shown effectiveness in improving foot circulation and neuropathy in several studies; however, to the best of our knowledge, no randomised controlled study has investigated its effectiveness for DFU healing. Therefore, this study aimed to assess the effects of Buerger-Allen exercise on the healing of DFUs in patients with type 2 diabetes.

Method: This is a parallel-group randomised controlled trial (RCT). Of 50 patients with neuropathic DFUs, 41 completed the study. They were assigned randomly to a study group (n=21) and a control group (n=20). Patients in the study group received the standard medical treatment and semi-supervised Buerger-Allen exercise for three sessions per week for four weeks, while patients in the control group only received the standard medical treatment. The outcome measures were: ankle-brachial pressure index (ABPI); ulcer size; ulcer depth; SINBAD score; and ulcer risk for poor outcomes (based on the SINBAD score).

Results: The study group's mean age was 49.48±6.45 years and the control group's mean age was 49.15±5.85. The study group's ABPI increased significantly compared to the baseline (1.17±0.04 versus 1.11±0.05, respectively; p<0.001) and the control group (1.17±0.04 versus 1.14±0.05, respectively; p=0.04) post-intervention. Ulcer size also reduced significantly in the study group compared to the baseline (2.63±2.0 versus 7.48±5.55cm2, respectively; p<0.001) and the control group (2.63±2.0 versus 6.43±4.45cm2, respectively; p<0.001) post-intervention. Ulcer depth decreased significantly in the study group compared to the baseline (1.71±1.05 versus 4.19±1.74mm, respectively; p<0.001) and the control group (1.71±1.05 versus 2.80±1.57mm, respectively; p=0.01) post-intervention. Furthermore, the SINBAD score in the study group decreased significantly compared to the baseline (1.38±0.86 versus 2.14±1.06, respectively; p<0.001) and the control group (1.38±0.86 versus 2.0±0.79, respectively; p=0.02) post-intervention. Moreover, the ulcer risk for poor outcomes, based on the SINBAD score, reduced significantly only in the study group, compared to the baseline (p=0.041). The control group showed non-significant changes compared to the baseline in all outcome measures (p>0.05).

Conclusion: From the findings of this RCT, Buerger-Allen exercise, in combination with standard wound care, may help accelerate the healing of neuropathic DFUs in patients with type 2 diabetes, and could be suggested as part of the management plan for such conditions as an easy-to-perform offloading exercise intervention.
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