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Exercise interventions for diabetic foot complications

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, May 10, 2014.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Exercise and Neuropathy: Systematic Review with Meta-Analysis
    Fiona Streckmann, Maryam Balke, Guido Cavaletti, Alexandra Toscanelli, Wilhelm Bloch, Bernhard F. Décard, Helmar C. Lehmann & Oliver Faude
    Sports Medicine volume 52, pages1043–1065 (2022)
     
  2. scotfoot

    scotfoot Well-Known Member

    An eye opening paper was published towards the end of last year which gives some solid results.

    The trial was controlled, randomized, and double- blind, and looked at a number of outcomes including "recurrence rate of plantar foot diabetic ulcers, HbA1c levels, diabetic neuropathy examination (DNE) scores, ankle brachial index (ABI), and walking speed within 12 and 24weeks."

    I only have access to the abstract but a couple of results jumped out at me :

    Ulcer recurrence at 24 weeks - intervention 16%, control 72% , that's a big difference, and
    "There were significant differences in the DNE score delta (P=0.000)" , DNE being a measure of neuropathy.


    doi: 10.1016/j.jdiacomp.2021.107968. Epub 2021 May 28.
    Effect of foot-ankle flexibility and resistance exercise in the secondary prevention of plantar foot diabetic ulcer

    Maria Suryani 1, Widiastuti Samekto 2, Heri-Nugroho 3, Hardhono Susanto 4, Luky Dwiantoro 4
    Affiliations expand
    Abstract

    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 24weeks.
    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 24weeks whichever came first. Outcome measures included plantar foot diabetic ulcer recurrence, changes of HbA1c levels, DNE scores, ankle brachial index ABI, and walking speed.
    Results: There were significant difference between groups in ulcer recurrence at either 12weeks (intervention 8%, control 68%, RR 0.288; 95% CI 0.156-0.534, P=0.000) within 12weeks. or 24weeks (intervention 16%, control 72%, RR 0.222; 95% CI 0.088-0.564, P=0.000).). There were significant differences in the DNE score delta (P=0.000) and walking speed delta (P=0.000), but there were no significant differences in the HbA1c delta and ABI delta between groups at either 12 or 24weeks.
    Conclusions: Foot-ankle flexibility and resistance exercises can reduce the recurrence of plantar foot diabetic ulcer incidence and improve diabetic neuropathy and walking speed. Clinical trial number: NCT04624516.
    Keywords: ABI; Diabetes; Diabetic foot ulcer; Diabetic neuropathy; Foot-ankle exercise; HbA1c.
     
  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot-ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial
    Renan L Monteiro et al
    Sci Rep. 2022 May 9;12(1):7561
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Physical Activity Participation in People With an Active Diabetic Foot Ulceration: A Scoping Review
    Magali Brousseau-Foley, Virginie Blanchette, François Trudeau, Julie Houle
    Can J Diabetes. 2022 Apr;46(3):313-327
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Weight-bearing physical activity in people with diabetes-related foot disease: A systematic review
    Jaap J van Netten, Vera M Fijen, Sicco A Bus
    Diabetes Metab Res Rev. 2022 Jun 6
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Should weight-bearing activity be reduced during healing of plantar diabetic foot ulcers, even when using appropriate offloading devices?
    Gustav Jarl et al
    Diabetes Res Clin Pract. 2021 May;175:108733
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of tap dance on plantar pressure, postural stability and lower body function in older patients at risk of diabetic foot: a randomized controlled trial
    Yanan Zhao et al
    BMJ Open Diabetes Research and Care 2021;9:e001909
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effects of a 12-Week Interventional Exercise Programme on Muscle Strength, Mobility and Fitness in Patients With Diabetic Foot in Remission: Results From BIONEDIAN Randomised Controlled Trial
    Eliška Vrátná et al
    Front Endocrinol (Lausanne). 2022 Jul 5;13:869128
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot Exercise and Related Outcomes in Patient With Diabetes Mellitus: A Literature Review
    Theodehild M. Theresia Dee et al
    International Journal of Nursing and Health Services (IJHNS)
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Effectiveness of Neuromuscular Taping (NMT) And Foot Exercise in Improving Microsirculations in Diabetes Mellitus Patients
    Indah Susanti, Fitri Arofiati
    Source
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A 12-Week Supervised Exercise Therapy Program for Patients with Diabetic Foot Ulcers: Program Development and Preliminary Feasibility
    Thomas Vedste Aagaard et al
    Int J Low Extrem Wounds. 2023 Jan 5
     
  13. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  14. scotfoot

    scotfoot Well-Known Member

    Extract from an interesting opinion piece in Podiatry Today with some wise words.


    However, clinicians are encouraged to take a more active look at the biomechanical aspects of diabetic neuropathy. Instead of watching the foot change slowly over the years, take note of the changes and adjust treatment plans accordingly. Clinicians can educate the patient on their increased fall risk. Prescribing appropriate footwear to help support the muscles and structure of the foot is another consideration. Encouraging exercise, physical therapy, and other means of maintaining muscle strength and joint mobility is also wise. Taking an active role in the care of patients with diabetic neuropathy may help prevent some of the morbidities associated with neuropathy and diabetes.

    https://www.hmpgloballearningnetwor...tch/biomechanical-effects-diabetic-neuropathy
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effect of exercise, physical activity, stepping characteristics, and loading on diabetic foot ulcer healing: a systematic review.
    Wendland DM et al
    Wounds : a Compendium of Clinical Research and Practice, 01 Jan 2023, 35(1):9-17
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Exercise in adults admitted to hospital with diabetes-related foot ulcers: a pilot study of feasibility and safety
    Emily Aitken et al
    J Foot Ankle Res. 2023 Mar 28;16(1):18
     
  17. scotfoot

    scotfoot Well-Known Member

    A new study has just been published on the subject of foot strengthening and the diabetic foot and it has disappointing results. Either the exercises used provided insufficient stimulus or foot strengthening in the patient group studied is difficult to achieve .


    5. Conclusions

    Although the intervention is easy to perform and showed a good adherence (72%), the 8-week home-based foot–ankle exercise program based on an educational booklet plus usual foot care is unlikely to be sufficient to improve the main modifiable risk factors related to foot ulcers. However, it seems to preserve the gait kinetics and pressure distribution pattern of the participants in the IG for 16 weeks, preventing the worsening of their condition. The effects of a home-based foot–ankle exercise in improving DPN-related outcomes and musculoskeletal and biomechanical deficits might not be as unequivocal as we hypothesized.

    Abstract

    Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot–ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot–ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 ± 6.4 years, 23.5 ± 4.8 kg/m2, males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 ± 9.4 years, 22.9 ± 3.6 kg/m2, males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (p = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect p = 0.020, mean difference = −64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (p = 0.007) and for the knee and hip at push off over 8 and 16 weeks (p < 0.001 and p = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot–ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot–ankle kinematics and kinetics.
    Effects of a Home-Based Foot–Ankle Exercise Program with Educational Booklet for Foot Dysfunctions in People with Diabetic Neuropathy: Results of the FOCA-II Randomized Controlled Clinical Trial

    Appl. Sci. 2023, 13(3), 1423; https://doi.org/10.3390/app13031423
    Received: 29 December 2022 / Revised: 13 January 2023 / Accepted: 17 January 2023 / Published: 20 January 2023
    (This article belongs to the Special Issue Diabetic Foot)
     
  18. scotfoot

    scotfoot Well-Known Member

    As far as I can make out these where the 6 exercises used by the researchers. Ok, so these exercises don't cut the mustard and a more effective means of strengthening the foot may give better results .

    I have never been a fan of calf raises or toe grabs as a means of foot strengthening and the results of this trial seem to support that position.

    [​IMG]
     
  19. scotfoot

    scotfoot Well-Known Member

    So why won't toe grabs (or toe curls) strengthen the foot, why am I confident about saying this?

    Well if you look at the figure below you can see that for the exercise shown on the right ( toe curl against metal ring and chain) ,activation of the abductor hallucis muscle is less than 40% of its maximal level as measured by EMG .

    If it's that low pulling against a specially devised loop and chain how much lower is it going to be doing toe pick ups or squeezing balls etc.

    But look at the doming exercise activation levels (figure on the left with an inelastic band over the top of the foot) .Much, much, higher.

    [​IMG]
     
  20. scotfoot

    scotfoot Well-Known Member

    So what about using calf raises to strengthen the intrinsic foot muscles ?

    Well, according to the most thorough piece of research done to date on the subject ( see below), calf raises of any type ,whether single or double leg ,done on a slope or a block , weight added or not, will not significantly strengthen the flexor muscles of the lesser toes. That's worth saying again : According to existing research, calf raises do not strengthen the muscles of the lesser toes.

    Furthermore, although single leg calf raises done on a slope and with increasing heavy load on a subjects back, may, in young people, give a significant hallux flexor gain, the gain is small compared to other methods of strengthening the foot.

    Based on Torstein et al 2023, I would contend that calf raises are a poor way of attempting to strengthen the hallux and a non starter when trying to strengthen the lesser toes.


    Research paper

    Effect of incline versus block heel-raise exercise on foot muscle strength and vertical jump performance – an 11-week randomized resistance training study Torstein E. Dæhlin, Michael D. Kennedy, Hossein Rouhani & Loren Z. F. Chiu To cite this article: Torstein E. Dæhlin, Michael D. Kennedy, Hossein Rouhani & Loren Z. F. Chiu (2023): Effect of incline versus block heel-raise exercise on foot muscle strength and vertical jump performance – an 11-week randomized resistance training study, Sports Biomechanics, DOI: 10.1080/14763141.2023.2176353 To link to this article: https://doi.org/10.1080/14763141.2023.2176353
     
    Last edited: Apr 20, 2023
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study
    Alba Gracia-Sánchez et al
    Braz J Phys Ther. 2023 Apr 6;27(2):100500
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Local microvascular tissue oxygenation of the intrinsic foot muscles in patients with diabetes: A cross-sectional case-comparison study
    Stephanie Stephens et al
    The Foot Volume 56, September 2023, 102035
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Summary of the best evidence on exercise for the prevention and treatment of diabetic foot
    Q J Guo et al
    Zhonghua Shao Shang Za Zhi. 2023 Jul 20;39(7):671-678
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    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
     
  25. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of Exercises for Strengthening the Intrinsic
    Muscles of the Foot and Improving Ankle
    Mobility on Patients of Diabetic Peripheral
    Neuropathy

    Daris Francis et al
    Cureus 16(3)
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot Sensitivity Increases in Diabetes Patients Who Are Given
    Range of Motion Exercise at Kabila Community Health
    Center : A Case Series

    Fakhriatul Falah et al
    Source
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effect of active range of motion exercise on foot sensitivity in type II diabetes mellitus patients
    Erliana Dwi Retna Asih et al
    Source
     
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