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Targeted exercises for the diabetic foot

Discussion in 'Diabetic Foot & Wound Management' started by scotfoot, Nov 6, 2023.

  1. scotfoot

    scotfoot Well-Known Member


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    I came across this on the internet and was startled by it. Does evidence about the benefits of strengthening the diabetic foot exist which has not been published, or have I just missed it?

    Here are some extracts from the piece.

    "ABSTRACT
    The "Total Toe", a training device for the toe flexor muscles, can reduce foot amputations for diabetics. Regular training has been shown to counteract muscle regression and reduce peak pressure under the foot - reducing problematic ulcerations and resulting foot amputations."

    "Development proceeded from a number of scientific studies on strength ability and functional adaptation of toe-bending musculature in physically active individuals. Clinical utility was documented in examinations of diabetic patients."

    "The training device was chosen for first place in the “Technologies for Healthy Movement” innovation competition at the German Sport University Cologne by an external panel of expert judges."
    Link https://lnkd.in/eNTzWaJa
    Activate to view larger image,
    [​IMG]
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I stopped reading at this sentence on that website:
    "Every year, there are 30,000 foot amputations in Germany due to diabetes. Total Toe could greatly reduce that number." .... nope
     
  3. scotfoot

    scotfoot Well-Known Member

    Below are figures for the UK, population about 67 million. Germany has a population of about 83 million so a figure of 3000 major amputations a year might be about right.


    Key Information
    During the three-year period of 2017/18 to 2019/20:
    • There were 171,759 foot disease-related hospital admissions for patients with diabetes.
    • 97,175 individual patients had a hospital admission for foot disease and 34% had more than one admission over the three years.
    • There were 7,957 major amputations with a directly standardised rate of 8.1 major amputations per 10,000 population with diabetes per year.
    • There were 21,738 minor amputations with a directly standardised rate of 22.1 minor amputations per 10,000 population with diabetes per year.
    • Patients with diabetes that are male, from the most deprived areas, aged over 65 or of white ethnicity had greater risk of amputation.
     
  4. scotfoot

    scotfoot Well-Known Member

    Having looked around a bit, a paper from Angela Hohne is all I can find on foot strengthening in neuropathic feet from the University of Cologne.

    Below is an abridged version from Matt Dilnot . What I can't find out is what sort of exercise equipment Hohne and her colleagues used, I can only guess .

    "There is now a growing body of research which demonstrates we can indeed reverse muscle atrophy in the forefoot, improve mobility of toes and when we do so we can reduce plantar pressures which crush the tissues under the foot (Allet et al., 2010; Sartor et al., 2014; Kanchanasamut and Pensri, 2017).
    An excellent example of such research was published by Höhne et al in Cologne, Germany (Höhne et al., 2012).

    Fourteen diabetic patients with only 30% of normal toe flexor strength performed toe flexor training with 70% of the maximal voluntary isometric contraction on for eight weeks, 3 days per week, 4 sets per session for twelve repetitions (3s loading/ 3s relaxation). The participants were divided into groups of either those with or without neuropathy. Seven had neuropathy, seven without neuropathy.

    The maximum strength of the toes was measured before and after the intervention and the volume of the intrinsic foot muscles was examined before and after the intervention using MRI.

    All patients improved strength, with the average increase being a staggering 55% increase in just 8 weeks. The intervention took only 10 minutes roughly 3 times per week and could be performed at home with little difficulty. In addition, there were no instructions to utilise their strength in everyday activities. So the strength gains can only be attributed to intervention of a total of 30 minutes per subject per week. Furthermore, the MRI results showed an average increase of 5% muscle bulk in just those 8 weeks.

    We can begin to understand the possible benefits if we were to perform these exercises every day, in a functional position, with functional loads (bodyweight) combined with daily use activities to create positive carry over."
     
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