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Lymphatic drainage from the foot

Discussion in 'Diabetic Foot & Wound Management' started by scotfoot, Feb 21, 2018.

  1. scotfoot

    scotfoot Active Member


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    So if the intrinsic foot musculature plays a crucial role in the movement of blood into and out of the foot , does it also have a crucial role to play in the efficient functioning of the lymphatic system of the foot ?

    Is the lymphatic system of the foot less efficient in the intrinsic minus foot and if so does this lead to an increased risk of foot infection ?

    With the intrinsic minus foot , can the musculature be restored by progressive resistance exercise , leading perhaps to a reduction in long term infections ?

    Any thoughts ?
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Just a couple of quick points:
    - lymph drainage is not so dependant on the muscle pump as venous return is
    - for the intrinsic minus foot, rehab nearly impossible as by definition the muscle wasting is due to a motor neuropathy
     
  3. scotfoot

    scotfoot Active Member

    Quote
    "- for the intrinsic minus foot, rehab nearly impossible as by definition the muscle wasting is due to a motor neuropathy "

    I am not sure how Karen Mickle managed to persuade her bosses that it was worth looking at a strengthening program in people with diabetic foot neuropathy and associated muscle weakness since , like you ,I thought rehab of the foot muscles in this case might be very difficult . However ,I certainly thought it was worth investigating .

    The research title is "Evaluating a foot strengthening exercise program to improve foot function and foot health in older adults with diabetes" but its status is currently unknown to me .

    At the risk of sounding a bit melodramatic , if the exercise regime used in the trial does significantly restore the intrinsics then Mickle and her colleagues won't just be edging open the therapeutic door , instead ,for a number of reasons , they will be kicking it off its hinges .
     
  4. scotfoot

    scotfoot Active Member

    Quote
    " lymph drainage is not so dependant on the muscle pump as venous return is"

    True . However , depending upon the tissue in which the lymphatics are found , lymph uptake and movement can be driven principally by intrinsic or extrinsic factors . In skeletal muscle , lymphatic function is driven mainly by extrinsic factors ,namely the contraction and relaxation of the skeletal muscles themselves .

    Diabetic neuropathy can lead to severe atrophy of the intrinsic muscles of the foot with highly organized skeletal muscle being replaced by poorly defined fatty infiltrate . I believe this type of pathology will likely lead to significant compromise of the existing lymphatic system and hence immun- compromised ,infection prone , zones within the foot .
    But if the intrinsics could be restored to some degree ...........
     
  5. scotfoot

    scotfoot Active Member

    [​IMG] So here is a wee gadget to measure toe flexor strength which ,with a bit of tweaking , ( taking measurements with the foot plantarflexed at the ankle and placing a strap across the top of the foot just proximal to the MTFJs ) , might be used by a podiatrist to evaluate foot function and intrinsic muscle health in patients with diabetic disease linked , intrinsic muscle atrophy .
    Armed with this information , and dependent on the results of Mickles' trial , above , it might be possible to slow or even reverse intrinsic muscle atrophy and restore a better level of health to the foot .

    Also a recent study ,below , has shown that foot exercises can help with foot ulcer healing . I have not seen the full paper and so do not know what exercise were used but it looks promising .

    So we could be approaching a point where a podiatrist could easily identify intrinsic toe flexor weakness in a diabetic patient and then help prevent ,or even help heal foot ulcers ,by prescribing and supervising a foot muscle exercise program . This would likely greatly benefit the patients in question and the burden of cost to the NHS .


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

    https://www.ncbi.nlm.nih.gov/pubmed/29261560
    by Ş Eraydin - ‎2017
    19 Dec 2017 - The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer. ... PURPOSE: The purpose of this study was to investigate the effect of foot exercises on wound healing in type 2 diabetic patients with a diabetic foot ulcer. DESIGN: Prospective, randomized controlled study.
     
  6. scotfoot

    scotfoot Active Member

    Note ..
    With regard to this quote from the previous post -
    " ( taking measurements with the foot plantarflexed at the ankle and placing a strap across the top of the foot just proximal to the MTFJs ) , might be used by a podiatrist to evaluate foot function "
    the strap across the top of the foot would be of an inelastic material and fix the midfoot area in position in the measuring device . The measurements would be made with the patient in a sitting position and the foot in a plantarflexed position at the ankle to limit the input of the external toe flexors .
     
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