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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 ?

 

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

 

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 .

 

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" 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 ...........

 

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.

 

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 .