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Hi all,

As a recent exercise physiologist graduate, i have joined the forum to use as a source of info. I also have a question regarding foot health & diabetes (with and without neuropathy). Am really after some advice and opinions.

Firstly, i would like to acknowledge that i am clear on the dangers of diabetics with peripheral neuropathy performing any activity in barefeet.

However i see a number of clients who have poor balance and awareness of what is happening with their feet. (These are more often the diabetics with neuropathy who have lost a degree of feeling/sensation in their feet, combined with age and lack of exercise).

My question is; Is their a case for diabetics without neuropathy performing specific exercises (in a controlled environment) and in barefeet to improve proprioception and intrinsic muscle function?

Also if anyone has read the following article, or has any views on it?

http://bjsm.bmj.com/content/early/2014/03/21/bjsports-2013-092690.short

Thanks for any advice or comments!

 

:welcome:

Yep. Its potentially life threatening. See this loon:
Barefooter giving advice to those with diabetes to go barefoot

The evidence is that they are more stable and have less postural instability wearing shoes:
Footwear and Gait Stability in Diabetic Patients with Peripheral Neuropathy

A case could be made, but prospective evidence lacking. See the studies in this thread:
Balance and diabetic neuropathy, esp post #5 in which there was a correlation between balance and muscle strength.

The only problem is that we do not know if you can actually "strengthen" muscles or "slow" the weakening of muscles in the context of a developing or preclinical motor neuropathy.

The other issue is I not convinced you can actually improve the proprioception as a preclinical decline in the proprioception occurs really early in diabetes, so not sure if "increased proprioceptive stimulation" can impact that developing decline.

Its a very flawed model, maybe even fatally flawed. That does not mean that there are no advantages to strengthening the intrinsics.
I reviewed that paper here:
The concept of ‘core stability’ of the foot and we had this thread on it: 'Core stability' of the foot

The basic problems with the model proposed are:
- they cherry picked the evidence - there were plenty of studies that they did not use that are inconsistent with what they were arguing (eg one study showed a lowering of arch height with intrinsic muscle strengthening; several studies show no correlation between muscle strength and arch height)
- in the motor neuropathy in diabetes in which only the intriniscs are affected, they develop a higher arched foot (the "intrinsic minus" foot) - the proposed model would predict the opposite --> flaw
- they are expecting a lot from some very very very small muscles that have a pretty useless lever arm to exert the effect that they claim it does (ie I not convinced!)
- the muscles they are talking about are not even active until the later half of the stance phase --> potentially a fatal flaw in their proposed model

...none of that means that there is not an advantage to exercise to strengthen them.