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Novaković-Bursać S, Talić G, Tomić N, Škrbić R, Soldatovic I. Effect of three-week exercise program on muscle strength and joint mobility in patients with diabetic polyneuropathy: Randomized controlled trial. World J Diabetes 2024; 15:2311-2321. [PMID: 39676803 PMCID: PMC11580598 DOI: 10.4239/wjd.v15.i12.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/28/2024] [Accepted: 10/09/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints. Evidence shows that a foot-related exercise program, combined with a health-promoting program, can improve the signs and symptoms of diabetic polyneuropathy, enhance gait, restore mobility in the foot and ankle joints, redistribute pressure while walking, and increase foot strength and function. As a result, these exercise programs can help mitigate the risk factors for diabetic foot ulceration. AIM To determine the effect of supervised stretching, strengthening, functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy. METHODS This was a randomized controlled trial conducted in a tertiary hospital. The study included 82 participants allocated into the intervention group (alpha-lipoic acid and exercise on 15 consecutive therapeutic days, n = 42) and control group (alpha lipoic acid only, n = 40). Muscle strength included dorsal and plantar flexors dynamometry and strength score, while range of motion included ankle, subtalar and first metatarsophalangeal joint goniometry. RESULTS Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15 (9.9 ± 7.2 vs 0.1 ± 3.3; P = 0.006) and month 6 (2.8 ± 7.3 vs -0.9 ± 4.1; P < 0.001), subtalar joint on day 15 (7.5 ± 5.1 vs -0.25 ± 2.25; P < 0.001) and month 6 (3.9 ± 6.4 vs -0.13 ± 3.49; P < 0.001). Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15 (2.62 ± 1.69 vs 0.10 ± 1.35; P < 0.001) and month 6 (0.66 ± 2.38 vs -0.75 ± 1.94; P = 0.004) as well as plantar flexors on day 15 (3.3 ± 1.6 vs 0.3 ± 1.5; P < 0.001) and month 6 (1.8 ± 2.2 vs -0.9 ± 2.1; P < 0.001). Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15 (-1.45 ± 1.42 vs -0.03 ± 0.16; P < 0.001) and month 6 (-1.17 ± 1.53 vs 0.20 ± 0.56; P < 0.001). CONCLUSION Exercise in combination with alpha-lipoic acid can improve joint mobility, as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.
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Affiliation(s)
- Snježana Novaković-Bursać
- Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović” Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina
| | - Goran Talić
- Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović” Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina
| | - Nataša Tomić
- Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović” Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina
| | - Ranko Škrbić
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatic, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Francis D, Kandaswami K, Padinhare Veedu P, Ponniah Subramanian A. Effect of Exercises for Strengthening the Intrinsic Muscles of the Foot and Improving Ankle Mobility on Patients of Diabetic Peripheral Neuropathy. Cureus 2024; 16:e56553. [PMID: 38646253 PMCID: PMC11027948 DOI: 10.7759/cureus.56553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objectives The study aimed to compare the efficacy of standard home care versus structured ankle mobility exercises in enhancing ankle and foot joint range of motion (ROM) among individuals with diabetes mellitus (DM). Additionally, it investigated the impact of foot intrinsic muscle strengthening exercises on hallux grip force in those with Diabetic Peripheral Neuropathy (DN). Materials and methods In a study of 200 patients with Diabetic Neuropathy (DN), selected from 345 screened diabetics with stable glucose levels and routine monitoring at a tertiary care facility, the efficacy of structured exercises versus standard care was evaluated. Participants, aged 40-70 years with mild neuropathic symptoms (neuropathy disability score of 3 to 5), were divided into two groups. Group 1 received standard care per International Diabetic Foot guidelines, while Group 2 performed targeted foot intrinsic muscle strengthening and ankle mobility exercises over eight weeks. The range of motion (ROM) for ankle and first metatarsophalangeal (MTP) joints and hallux grip force were measured, showing significant improvements in Group 2. Analysis was done using IBM SPSS. Results The average age of the individuals in group 1 (n=100) was 53.87±5.42 years, whereas the average age of the subjects in group 2 (n=100) was 54.23±4.69 years. The study included a total of 97 male participants, with 48 in group 1 and 49 in group 2. The groups exhibited homogeneity in terms of age, gender, duration of DM, and BMI (p>,0.05). When comparing the ROM for ankle dorsiflexion between the groups, it was shown that subjects in group 2 had a substantially higher ROM following exercise for both the right (27.97°±5.3° Vs 19.24°±2.54°) and left (28.55°±4.61° Vs 18.22°±1.14°) ankles compared to the patients in group 1 (p<,0.01). Nevertheless, there were statistically insignificant differences (p>,0.05) observed within the groups, both before and after the exercises, for all the variables examined except for right and left ankle dorsiflexion, and right ankle plantarflexion in group 2. Group 2 subjects exhibited a considerably greater hallux grip force compared to group 1 subjects. The mean enhanced paper grip strength for the right and left big toe of group 2 was 44±3.58 N and 43.2±2.62 N respectively. The mean enhanced paper grip force for the right and left big toe of group 1 was 38±3.11 N and 37.92±2.13 N respectively. A statistically highly significant difference was observed for hallux grip force between the groups (p<,0.01). Conclusion The findings of this study suggest that performing the foot intrinsic muscle strengthening and ankle mobility exercises on the foot and ankle joints can potentially enhance ROM and hallux grip force in patient groups with DN.
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Affiliation(s)
- Daris Francis
- Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND
| | - Kotteeswaran Kandaswami
- Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND
| | - Pramod Padinhare Veedu
- Department of Physiotherapy, Lourde Institute of Allied Health Sciences, Thaliparamba, IND
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Han Y, Jiang Y, Xu D, Shi S, Zhang Q, Zhang Y, Feng J, Tan L, Li K. Green preparation of antibacterial shape memory foam based on bamboo cellulose nanofibril and waterborne polyurethane for adaptive relief of plantar pressure. Int J Biol Macromol 2024; 256:128444. [PMID: 38035958 DOI: 10.1016/j.ijbiomac.2023.128444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
This study developed an aqueous solution blending and freeze-drying method to prepare an antibacterial shape memory foam (WPPU/CNF) based on waterborne PHMG-polyurethane and cellulose nanofibers derived from bamboo in response to the increasing demand for environmentally friendly, energy conserving, and multifunctional foams. The obtained WPPU/CNF composite foam has a highly porous network structure with well-dispersed CNFs forming hydrogen bonds with the WPPU matrix, which results in a stable and rigid cell skeleton with enhanced mechanical properties (80 KPa) and anti-abrasion ability. The presence of guanidine in the polyurethane chain endowed the WPPU/CNF composite foam with an instinctive and sustained antibacterial ability against Escherichia coli and Staphylococcus aureus. The WPPU/CNF composite foam exhibited a water-sensitive shape memory function in a cyclic shape memory program because of the chemomechanical adaptability of the hydrogen-bonded network of CNFs in the elastomer matrix. The shape-fixation ratio for local compression reached 95 %, and the shape-recovery rate reached 100 %. This allows the WPPU/CNF pad prototype to reversibly adjust the undulation height to adapt to plantar ulcers, which can reduce the local plantar pressure by 60 %. This study provides an environmentally friendly strategy for cellulose-based composite fabrication and enriches the design and application of intelligent foam devices.
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Affiliation(s)
- Yanting Han
- West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuanzhang Jiang
- College of Biomass Science and Engineering, Key Laboratory of Biomass Fibers for Medical Care in Textile Industry, Sichuan University, Chengdu, China
| | - Dingfeng Xu
- Division of Glycoscience, Department of Chemistry, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, AlbaNova University Centre, Stockholm, Sweden
| | - Shuo Shi
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Qiang Zhang
- College of Biomass Science and Engineering, Key Laboratory of Biomass Fibers for Medical Care in Textile Industry, Sichuan University, Chengdu, China
| | - Yong Zhang
- College of Biomass Science and Engineering, Key Laboratory of Biomass Fibers for Medical Care in Textile Industry, Sichuan University, Chengdu, China
| | - Jinhua Feng
- West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Tan
- College of Biomass Science and Engineering, Key Laboratory of Biomass Fibers for Medical Care in Textile Industry, Sichuan University, Chengdu, China; Sate Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China.
| | - Ka Li
- West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China.
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Lepesis V, Paton J, Rickard A, Latour JM, Marsden J. Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT. J Foot Ankle Res 2023; 16:88. [PMID: 38057930 DOI: 10.1186/s13047-023-00690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs. DESIGN AND METHODS Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance. RESULTS At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%). CONCLUSIONS Combining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk. TRIAL REGISTRATION https://classic. CLINICALTRIALS gov/ct2/show/NCT03195855 .
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Affiliation(s)
- Vasileios Lepesis
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alec Rickard
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jonathan Marsden
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
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Monteiro RL, Ferreira JSSP, Silva ÉQ, Cruvinel-Júnior RH, Veríssimo JL, Bus SA, Sacco ICN. Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trial. Braz J Phys Ther 2023; 27:100517. [PMID: 37348358 DOI: 10.1016/j.bjpt.2023.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/22/2022] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Follow-up report of secondary outcomes of a randomized, single-blinded, parallel controlled trial that investigated the benefits of a foot-ankle therapeutic exercise program on foot-ankle kinematics, plantar pressure, and lower limb kinetics during gait in individuals with diabetic neuropathy (DPN). METHODS Sixty-six participants with DPN were randomly allocated into a control group (CG; n = 31), which received usual care, and an intervention group (IG; n = 35), which received usual care plus a 12-week group-based foot-ankle exercise program. Outcomes were assessed at baseline and 12 weeks by an assessor blinded to group allocation. RESULTS The generalized linear mixed model and intention-to-treat analysis revealed a greater hip extensor moment at push-off and greater hallux contact area in the IG than CG after 12 weeks. A within-group analysis revealed a larger arch height during stance and higher peak pressure and pressure-time integral at the central forefoot region in the IG after 12 weeks compared to baseline. There were no other significant group difference or changes over time in foot-ankle kinematics or in any other joint moment related to overall lower limb biomechanics. CONCLUSION The increases in hip moment at push-off and hallux surface contact area suggest an improvement in the propulsion phase with greater participation of the toes in foot rollover after 12 weeks of a group-based foot-ankle exercises program for people with DPN. Individual face-to-face, longer-term, and more intensive interventions may be needed to positively influence foot-ankle biomechanics and pressure parameters in other plantar areas.
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Affiliation(s)
- Renan L Monteiro
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Department of Health and Biological Science, Universidade Federal do Amapá, Macapá, AP, Brazil
| | - Jane S S P Ferreira
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Érica Q Silva
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ronaldo H Cruvinel-Júnior
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jady L Veríssimo
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Tanaka Y, Ueno T. Results of Neuropathy Screening Test for Lower Limb Amputees With Diabetes Mellitus and Their Prosthetic Rehabilitation: A Cross-Sectional Study. Cureus 2023; 15:e40352. [PMID: 37456474 PMCID: PMC10339356 DOI: 10.7759/cureus.40352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction To prevent foot ulcers and subsequent amputation on the non-amputated side, we conducted tests for diabetic neuropathy. The results were then used in prosthetic rehabilitation for lower limb amputees with diabetes mellitus. Materials and methods This cross-sectional retrospective study included patients admitted to our convalescent rehabilitation ward for prosthetic rehabilitation between April 2019 and December 2022 following lower limb amputation due to diabetes. We investigated the positive rate of the modified Ipswich Touch Test (mIpTT) in lower limb amputees with diabetes, and physical and orthotic therapy and prosthetic rehabilitation based on medical records. Results Twenty-seven transtibial amputees and nine transfemoral amputees had diabetes. The mIpTT results were positive in 22 (81%) transtibial and eight (89%) transfemoral amputees. There were no apparent differences in positivity rates by amputation level, gender, or age. Based on these results, personalized physical therapy and insoles were prescribed for the non-amputee foot in parallel with prosthetic rehabilitation. Conclusions Lower limb amputees with diabetes have diabetic neuropathy more frequently than diabetic patients without amputation. As a result, they may also be at a higher risk of developing foot ulcers and subsequent amputation due to neuropathy. Therefore, rehabilitation to prevent amputation on the non-amputated side of lower limb amputees with diabetes had better encompassing foot exercises and orthotic therapy on the non-amputated side during the prosthetic rehabilitation period.
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Affiliation(s)
- Yohei Tanaka
- Rehabilitation Medicine, JR Tokyo General Hospital, Tokyo, JPN
| | - Takaaki Ueno
- Rehabilitation Medicine, JR Tokyo General Hospital, Tokyo, JPN
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Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective. J Biomech 2023; 154:111604. [PMID: 37159980 DOI: 10.1016/j.jbiomech.2023.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.
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Affiliation(s)
- Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil; Master's and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Eneida Yuri Suda
- Postgraduate Program in Physiotherapy, Universidade Ibirapuera, São Paulo, Brazil
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Gracia-Sánchez A, López-Pineda A, Lázaro-Martínez JL, Pérez A, Pomares-Gómez FJ, Fernández-Seguín LM, Gil-Guillén VF, Chicharro-Luna E. Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study. Braz J Phys Ther 2023; 27:100500. [PMID: 37079949 DOI: 10.1016/j.bjpt.2023.100500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Patients with diabetes mellitus are exposed to important complications. Currently little evidence exist on the guidelines that these patients, at some risk of foot ulceration, should follow for physical exercise. OBJECTIVES To reach a consensus among multidisciplinary and international experts on physical activity/exercise recommendations for patients with diabetes, according to foot ulcer risk. METHODS Using a three-round Delphi method, a panel composed of 28 multidisciplinary experts in the management of diabetic foot assessed 109 recommendations on physical activity/exercise for patients with diabetes mellitus, according to their risk of foot ulcer. Consensus was assumed when 80% of responses matched the same category (agreement/disagreement). RESULTS Twenty-nine experts participated in the first and second rounds of consultation, and twenty-eight did so in the third, reaching final agreement on 86 of the 109 recommendations considered (78.9%). The study, thus, generated a consensus set of recommendations concerning different aspects of diabetic footcare before, during, and after exercise (e.g. when to examine the foot, how to assess it, what type of sock and insole to use, what types of exercise to perform, and when it is advisable to return to activity after an ulceration). CONCLUSION This Delphi study generated recommendations based on the consensus of international experts on physical activity and exercise by patient with diabetes at risk of ulceration. Recommendations considered the state of the foot and the patient's history and status before physical activity and included information on intensity, duration, frequency, and progressions of physical activity/exercise, and the use of custom-made plantar orthoses, shoe prescription, and the convenience of returning to physical activity after an ulceration.
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Affiliation(s)
- Alba Gracia-Sánchez
- Nursing Service, Department of Health and Behavioral Sciences, Faculty of Medicine, University Miguel Hernández de Elche, San Juan de Alicante, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, University Miguel Hernández de Elche, San Juan de Alicante, Spain; Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Alicante, Spain.
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit,Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Antonio Pérez
- Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Medicine Department, Universitat Autònoma de Barcelona, CIBER de Diabetes y Enfermedades metabólicas (CIBERDEM), Barcelona, Spain
| | | | | | - Vicente F Gil-Guillén
- Clinical Medicine Department, University Miguel Hernández de Elche, San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Alicante, Spain; Research Unit, University General Hospital of Elda, Elda, Spain
| | - Esther Chicharro-Luna
- Nursing Service, Department of Health and Behavioral Sciences, Faculty of Medicine, University Miguel Hernández de Elche, San Juan de Alicante, Spain
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Maeshige N, Moriguchi M, Fujii M, Kanazawa H, Yoshikawa Y, Kitamura K, Okuno F, Yamaguchi A, Uemura M, Hosomi M, Hara K, Terashi H, Fujino H. Acute Effects of Combination Therapy by Triceps Surae Stretching and Electrical Stimulation to the Tibialis Anterior on Medial Forefoot Plantar Pressure During Gait in Patients With Diabetes Mellitus. INT J LOW EXTR WOUND 2023:15347346221148456. [PMID: 36594523 DOI: 10.1177/15347346221148456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
High plantar flexor moment and limited ankle mobility are known to cause high plantar pressure under the forefoot. Stretching is an effective physical therapy for the limited ankle range of motion (ROM), and electrical stimulation is used to regulate the activity of antagonistic muscle via the action of reciprocal inhibition. Additionally, stretching paired with electrical stimulation has been reported to improve the limited ROM significantly. This study aims to investigate the influences of stretching on triceps surae (STR), electrical stimulation to tibialis anterior (ES), and the combination (ES+STR) on the ROM, kinematic parameters, and plantar pressure distribution during gait in patients with diabetes mellitus. Planter pressure and other parameters were measured before and after the intervention of ES, STR, ES+STR, or the rest sitting on the bed (CON) for 10 min. Pressure time integral under the medial forefoot decreased in the ES+STR compared to CON (P< .05). Interestingly, ES+STR increased passive and dynamic ROM on ankle dorsiflexion during gait and increased the lateral center of pressure excursion (P < .05). Furthermore, these changes were followed by decreased contact duration under the medial forefoot (P < .05). The combined therapy improves ankle mobility during gait and reduces the contact duration and the plantar pressure under the medial forefoot in patients with diabetes mellitus.
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Affiliation(s)
- Noriaki Maeshige
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Maiki Moriguchi
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hoshinori Kanazawa
- Graduate School of Information Science and Technology, 13143The University of Tokyo, Tokyo, Japan
| | - Yoshiyuki Yoshikawa
- Department of Rehabilitation, Faculty of Health Sciences, 12968Naragakuen University, Nara, Japan
| | | | - Fumiya Okuno
- Department of Rehabilitation, Eikokai Ono Hospital, Ono, Japan
| | - Atomu Yamaguchi
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | | | - Kenta Hara
- 36719Kita-Harima Medical Center, Ono, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, 12885Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
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Cruvinel-Júnior RH, Ferreira JSSP, Veríssimo JL, Monteiro RL, Suda EY, Silva ÉQ, Sacco ICN. Could an Internet-Based Foot-Ankle Therapeutic Exercise Program Modify Clinical Outcomes and Gait Biomechanics in People with Diabetic Neuropathy? A Clinical Proof-of-Concept Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:9582. [PMID: 36559949 PMCID: PMC9781221 DOI: 10.3390/s22249582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Previous studies have shown the efficacy of foot-ankle exercises in people with diabetic peripheral neuropathy (DPN), but the quality of evidence is still low. This proof-of-concept study pursues preliminary evidence for potential clinical and gait biomechanical benefits from an internet-based foot-ankle therapeutic exercise program for people with DPN. We randomized 30 individuals with DPN (IWGDF risk category 1 or 2) into either the control group (CG) receiving the usual care or the intervention group (IG) receiving the usual care plus an internet-based foot-ankle exercise program, fully guided by the Sistema de Orientação ao Pé Diabético (SOPeD; translation: Diabetic Foot Guidance System) three times per week for 12 weeks. We assessed face-to-face clinical and biomechanical outcomes at baseline, 12 weeks, and 24 weeks (follow up). Participants had good adherence to the proposed intervention and it led to only mild adverse events. The IG showed improvements in the ankle and first metatarsophalangeal joint motion after 12 and 24 weeks, changed forefoot load absorption during foot rollover during gait after 24 weeks, reduced foot pain after 12 weeks, and improved foot function after 24 weeks. A 12-week internet-based foot-ankle exercise program using the SOPeD software (version 1.0) has the potential to reduce foot pain, improve foot function, and modify some important foot-ankle kinematic outcomes in people with DPN.
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Affiliation(s)
- Ronaldo H. Cruvinel-Júnior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Jane S. S. P. Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Jady L. Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Renan L. Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
- . Department of Biological and Health Science, Federal University of Amapá, Rod. Juscelino Kubitschek, km 02—Jardim Marco Zero, Macapá 68903-419, AP, Brazil
| | - Eneida Y. Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
- Postgraduate Program in Physical Therapy, Ibirapuera University, Av. Interlagos, 1329—Chácara Flora, São Paulo 04661-100, SP, Brazil
| | - Érica Q. Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Isabel C. N. Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
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Kaminski MR, Golledge J, Lasschuit JWJ, Schott KH, Charles J, Cheney J, Raspovic A. Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:53. [PMID: 35791023 PMCID: PMC9258081 DOI: 10.1186/s13047-022-00534-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no current Australian guidelines on the prevention of diabetes-related foot ulceration (DFU). A national expert panel aimed to systematically identify and adapt suitable international guidelines to the Australian context to create new Australian evidence-based guidelines on prevention of first-ever and/or recurrent DFU. These guidelines will include for the first-time considerations for rural and remote, and Aboriginal and Torres Strait Islander peoples. METHODS The National Health and Medical Research Council procedures were followed to adapt suitable international guidelines on DFU prevention to the Australian health context. This included a search of public databases after which the International Working Group on the Diabetic Foot (IWGDF) prevention guideline was deemed the most appropriate for adaptation. The 16 IWGDF prevention recommendations were assessed using the ADAPTE and GRADE systems to decide if they should be adopted, adapted or excluded for the new Australian guideline. The quality of evidence and strength of recommendation ratings were re-evaluated with reference to the Australian context. This guideline underwent public consultation, further revision, and approval by national peak bodies. RESULTS Of the 16 original IWGDF prevention recommendations, nine were adopted, six were adapted and one was excluded. It is recommended that all people at increased risk of DFU are assessed at intervals corresponding to the IWGDF risk ratings. For those at increased risk, structured education about appropriate foot protection, inspection, footwear, weight-bearing activities, and foot self-care is recommended. Prescription of orthotic interventions and/or medical grade footwear, providing integrated foot care, and self-monitoring of foot skin temperatures (contingent on validated, user-friendly and affordable systems becoming available in Australia) may also assist in preventing DFU. If the above recommended non-surgical treatment fails, the use of various surgical interventions for the prevention of DFU can be considered. CONCLUSIONS This new Australian evidence-based guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.
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Affiliation(s)
- Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
- Department of Podiatry, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Joel W J Lasschuit
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, New South Wales, Australia
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Karl-Heinz Schott
- Southern Cross University School of Health and Human Sciences / Pedorthics, Gold Coast, Queensland, Australia
| | - James Charles
- First Peoples Health Unit, Health Group, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Cheney
- Diabetes Victoria, Melbourne, Victoria, Australia
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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12
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Foot-ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial. Sci Rep 2022; 12:7561. [PMID: 35534614 PMCID: PMC9082985 DOI: 10.1038/s41598-022-11745-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/29/2022] [Indexed: 11/08/2022] Open
Abstract
This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN. Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).
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Lepesis V, Marsden J, Paton J, Rickard A, Latour JM. Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial. J Foot Ankle Res 2022; 15:7. [PMID: 35093130 PMCID: PMC8801130 DOI: 10.1186/s13047-022-00512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/12/2022] [Indexed: 01/18/2023] Open
Abstract
Background The benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered. Aim To explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period. Design An embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis. Participants Purposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited. Results Analysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities. Conclusion Our findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00512-z.
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Davis IS, Hollander K, Lieberman DE, Ridge ST, Sacco ICN, Wearing SC. Stepping Back to Minimal Footwear: Applications Across the Lifespan. Exerc Sport Sci Rev 2021; 49:228-243. [PMID: 34091498 DOI: 10.1249/jes.0000000000000263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 yr, most footwear has become increasingly more cushioned and supportive. Here, we review evidence that minimal shoes are a better match to our feet, which may result in a lower risk of musculoskeletal injury.
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Affiliation(s)
- Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | | | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge MA
| | - Sarah T Ridge
- Department of Exercise Sciences, Brigham Young University, Salt Lake City, Utah
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Suryani M, Samekto W, Susanto H, Dwiantoro L. Effect of foot-ankle flexibility and resistance exercise in the secondary prevention of plantar foot diabetic ulcer. J Diabetes Complications 2021; 35:107968. [PMID: 34187716 DOI: 10.1016/j.jdiacomp.2021.107968] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
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.
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Affiliation(s)
- Maria Suryani
- Nursing Study Program, St. Elisabeth School Health Science (STIKES St.Elisabeth), Semarang, Indonesia; Medicine Faculty, Diponegoro University, Semarang, Indonesia.
| | - Widiastuti Samekto
- Medicine Faculty, Diponegoro University, Semarang, Indonesia; St. Elisabeth Hospital, Semarang, Indonesia
| | | | - Luky Dwiantoro
- Medicine Faculty, Diponegoro University, Semarang, Indonesia
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Silva ÉQ, Santos DP, Beteli RI, Monteiro RL, Ferreira JSSP, Cruvinel-Junior RH, Donini A, Verissímo JL, Suda EY, Sacco ICN. Feasibility of a home-based foot-ankle exercise programme for musculoskeletal dysfunctions in people with diabetes: randomised controlled FOotCAre (FOCA) Trial II. Sci Rep 2021; 11:12404. [PMID: 34117342 PMCID: PMC8196027 DOI: 10.1038/s41598-021-91901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/02/2021] [Indexed: 11/09/2022] Open
Abstract
This study sought to assess the feasibility of design, adherence, satisfaction, safety and changes in outcomes followed by a home-based foot–ankle exercise guided by a booklet in individuals with diabetic peripheral neuropathy (DPN). 20 participants were allocated usual care [control group (CG)] or usual care plus home-based foot–ankle exercises [intervention group (IG)] for 8 weeks. For feasibility, we assessed contact, preliminary screening and recruitment rates, adherence, and using a 5-point Likert scale to satisfaction and safety of the booklet. In the IG, we assessed preliminary changes in DPN symptoms, DPN severity (classified by a fuzzy model) and foot–ankle range of motion between baseline and Week 8. In the first 20 weeks, 1310 individuals were screened for eligibility by phone contact. Contact rate was 89% (contacted participants/20w), preliminary screening success 28% (participants underwent screening/20w), and recruitment rate 1.0 participants/week (eligible participants/20w). The recruitment rate was less than the ideal rate of 5 participants/week. The adherence to the exercises programme was 77%, and the dropout was 11% and 9% for the IG and CG, respectively. In the IG, participants’ median level of satisfaction was 4 (IQR: 4–5) and perceived safety was 3 (IQR: 3–5). IG significantly decreased the DPN severity (p = 0.020), increased hallux relative to forefoot (first metatarsal) range of motion (ROM) (p < 0.001) and decreased maximum forefoot relative to hindfoot (midfoot motion) dorsiflexion during gait (p = 0.029). The home-based programme was feasible, satisfactory, safe and showed preliminary positive changes in DPN severity and foot motion during gait. Trial Registration ClinicalTrials.gov, NCT04008745. Registered 02/07/2019. https://clinicaltrials.gov/ct2/show/NCT04008745.
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Affiliation(s)
- Érica Q Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Danilo P Santos
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Raquel I Beteli
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Renan L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil.,Department of Physical Therapy, Universidade Federal do Amapá, Amapá, Brazil
| | - Jane S S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Ronaldo H Cruvinel-Junior
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Asha Donini
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Jady L Verissímo
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Eneida Y Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil.,Department of Physical Therapy, Universidade Ibirapuera, São Paulo, SP, Brazil
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil.
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Lorkowski J, Gawronska K. Pedobarography in Physiotherapy: A Narrative Review on Current Knowledge. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1375:13-22. [PMID: 33914289 DOI: 10.1007/5584_2021_636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pedobarography is a modern technology enabling the assessment of the locomotor system based on the plantar pressure distribution. The technic is useful in the rehabilitation of various types of dysfunction of body movement. This chapter aims to describe the application of pedobarography in clinical therapy. The qualitative analysis is based on a review of articles in English, French, German, Polish, Portuguese, Spanish, Turkish, and Chinese in Medline/PubMed, Cochrane Library, Embase, and PEDro databases. The search covered the articles on clinical trials, randomized controlled trials, meta-analyses, and reviews published over 1984-2020. The literature shows that pedobarography is a safe non-invasive method that is useful for the examination of foot biomechanics with a reference to the entire musculoskeletal system. A pedobarographic examination enables insight into a motion disorder, its plausible relation to a systemic pathology, and monitoring the course of treatment and rehabilitation.
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Affiliation(s)
- Jacek Lorkowski
- Clinical Department of Orthopedics, Traumatology and Sports of the Central Clinical Hospital of the Ministry of the Internal Affairs and Administration, Warsaw, Poland.
- Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | - Karolina Gawronska
- Rehabilitation Centre of the Central Clinical Hospital of the Ministry of the Internal Affairs and Administration, Warsaw, Poland
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18
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Cruvinel Júnior RH, Ferreira JSSP, Beteli RI, Silva ÉQ, Veríssimo JL, Monteiro RL, Suda EY, Sacco ICN. Foot-ankle functional outcomes of using the Diabetic Foot Guidance System (SOPeD) for people with diabetic neuropathy: a feasibility study for the single-blind randomized controlled FOotCAre (FOCA) trial I. Pilot Feasibility Stud 2021; 7:87. [PMID: 33766146 PMCID: PMC7995736 DOI: 10.1186/s40814-021-00826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetic neuropathy dramatically affects musculoskeletal structure and function of the lower limbs by impairing their muscle strength and mobility. Specific muscle strengthening through physiotherapy strategies appears to be promising; however, adherence to physiotherapy treatment is low in people with chronic diseases. Thus, an internet-based foot-ankle exercise program was created as a potential telerehabilitation alternative for people with diabetes to improve their self-monitoring and self-care management. This study assessed the feasibility, safety, acceptability, and changes in foot health and neuropathy symptoms in people with diabetes after 12 weeks of the intervention program with the Sistema de Orientação ao Pé diabético - Diabetic Foot Guidance System (SOPeD). METHODS Fourteen individuals were recruited and randomized to either the usual care (control group) or usual care plus an internet-based foot-ankle exercise program through SOPeD (intervention group) three times per week for 12 weeks. For feasibility, we assessed contact and recruitment rates per week; program adherence, determined as completing over 70% of the 36 sessions; and participant satisfaction and safety assessed through a questionnaire and scored on a 5-point Likert scale. We assessed changes in neuropathy symptoms and foot health and functionality from baseline to 12 weeks estimating differences or median of differences and 95% confidence intervals in the intervention group. RESULTS In 24 weeks, of the 822 patients in the database, 192 were contacted, 65 were assessed for eligibility, and 20 were considered eligible. The recruitment rate was 0.83 participants per week. Fourteen out of the 20 eligible participants agreed to participate, resulting in recruitment success of 70%. Adherence to the program was 66.7%, and there was no dropout. Participants' median level of satisfaction was 5.0 (IQR: 4.5-5.0) and perceived safety was 5.0 (IQR: 5.0-5.0). CONCLUSION The internet-based foot-ankle exercise program using SOPeD is feasible, satisfactory, and safe. Although this study had moderate adherence and a zero-dropout rate, recruitment needs to be improved in the larger trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT04011267 . Registered on 8 July 2019.
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Affiliation(s)
- Ronaldo H Cruvinel Júnior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Jane S S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Raquel I Beteli
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Érica Q Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Jady L Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Renan L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
- Department of Physical Therapy, Federal University of Amapá, Amapá, Brazil
| | - Eneida Y Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
- Department of Physical Therapy, Ibirapuera University, São Paulo, SP, Brazil
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil.
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Tran MM, Haley MN. Does exercise improve healing of diabetic foot ulcers? A systematic review. J Foot Ankle Res 2021; 14:19. [PMID: 33743791 PMCID: PMC7980337 DOI: 10.1186/s13047-021-00456-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/11/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND For patients with diabetic foot ulcers, offloading is one crucial aspect of treatment and aims to redistribute pressure away from the ulcer site. In addition to offloading strategies, patients are often advised to reduce their activity levels. Consequently, patients may avoid exercise altogether. However, it has been suggested that exercise induces an increase in vasodilation and tissue blood flow, which may potentially facilitate ulcer healing. The aim of this systematic review was to determine whether exercise improves healing of diabetic foot ulcers. REVIEW We conducted a systematic search of MEDLINE, CINAHL and EMBASE between July 6, 2009 and July 6, 2019 using the key terms and subject headings diabetes, diabetic foot, physical activity, exercise, resistance training and wound healing. Randomised controlled trials were included in this review. Three randomised controlled trials (139 participants) were included in this systematic review. All studies incorporated a form of non-weight bearing exercise as the intervention over a 12-week period. One study conducted the intervention in a supervised setting, while two studies conducted the intervention in an unsupervised setting. Two studies found greater improvement in percentage wound size reduction in the intervention group compared with the control group, with one of these studies achieving statistically significant findings (p < 0.05). The results of the third study demonstrated statistically significant findings for total wound size reduction (p < 0.05), however results were analysed within each treatment group and not between groups. CONCLUSION This systematic review found there is insufficient evidence to conclusively support non-weight bearing exercise as an intervention to improve healing of diabetic foot ulcers. Regardless, the results demonstrate some degree of wound size reduction and there were no negative consequences of the intervention for the participants. Given the potential benefits of exercise on patient health and wellbeing, non-weight bearing exercise should be encouraged as part of the management plan for treatment of diabetic foot ulcers. Further research is required to better understand the relationship between exercise and healing of diabetic foot ulcers.
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Affiliation(s)
- Morica M Tran
- Department of Podiatry, Eastern Health, Melbourne, Victoria, 3128, Australia.
| | - Melanie N Haley
- Department of Aged and Complex Medicine, Eastern Health, Melbourne, Victoria, 3128, Australia
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Paton J, Abey S, Hendy P, Williams J, Collings R, Callaghan L. Behaviour change approaches for individuals with diabetes to improve foot self-management: a scoping review. J Foot Ankle Res 2021; 14:1. [PMID: 33407755 PMCID: PMC7788877 DOI: 10.1186/s13047-020-00440-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research. METHODOLOGY Arksey and Malley's (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function. RESULTS In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes. CONCLUSION This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.
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Affiliation(s)
- Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK.
| | - Sally Abey
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Phil Hendy
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Jennifer Williams
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Richard Collings
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Lynne Callaghan
- Penninsula Medical School, Faculty of Health, University of Plymouth, John Bull Building Plymouth Science Park, Plymouth, PL6 8BT, UK
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Sahillioglu A, Cerrahoglu L. The relationship of the foot and ankle structure with overuse injuries in licensed footballers: a prospective cohort study. J Sports Med Phys Fitness 2020; 61:1499-1508. [PMID: 33337111 DOI: 10.23736/s0022-4707.20.11780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Foot and ankle are some of the most frequently injured places in football players' bodies. Overuse injuries have an insidious onset and can restrain athletes from sports temporary or even permanently. This study aimed to investigate the relationship between the clinical evaluation of the foot and ankle and findings obtained from foot plantar pressure measurements with the development of overuse injury, during the one-year follow-up. METHODS One hundred licensed football players were included in the study. Presence of joint hypermobility, foot posture assessment, ankle and first metatarsophalangeal joint range of motion measurements, pedobarographic plantar pressure assessment of foot was carried out. Then, the footballers were followed for 12 months for the development of new foot and ankle overuse injuries, and the clinical and pedobarographic data of the footballers with at least one injury were compared with the group without injury. RESULTS We found asymmetric pressure distribution between the preferred and non-preferred foot in the group who had an injury in the pedobarographic static foot plantar pressure measurements (P=0.040). A statistically significant limitation was found in the ankle eversion, first metatarsophalangeal joint dorsiflexion and ankle plantar flexion degrees in the injured group compared to the uninjured group (P=0.029, P=0.023, P=0.044, respectively). CONCLUSIONS These findings suggest that impairments in foot plantar pressure distribution and limitations in ankle and foot joint range of motion may be risk factors for the development of foot and ankle overuse injury.
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Affiliation(s)
- Ali Sahillioglu
- Unit of Physiatry, Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey -
| | - Lale Cerrahoglu
- Celal Bayar University Medical School, Department of Physical Medicine and Rehabilitation, Manisa, Turkey
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22
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Monteiro RL, Ferreira JS, Silva ÉQ, Donini A, Cruvinel-Júnior RH, Verissímo JL, Bus SA, Sacco IC. Feasibility and Preliminary Efficacy of a Foot-Ankle Exercise Program Aiming to Improve Foot-Ankle Functionality and Gait Biomechanics in People with Diabetic Neuropathy: A Randomized Controlled Trial. SENSORS 2020; 20:s20185129. [PMID: 32916792 PMCID: PMC7570556 DOI: 10.3390/s20185129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023]
Abstract
Foot-ankle strengthening and mobility exercises are part of international guideline recommendations for people at risk of diabetic foot disease. We examined the feasibility and preliminary efficacy of a 12-week foot-ankle exercise program on clinical, functional and biomechanical outcomes in people with diabetic neuropathy (DPN). We randomly allocated 30 people with DPN to usual care (control) or usual care plus a supervised exercise program (intervention). For feasibility, we assessed recruitment rate and participant adherence and satisfaction. For program efficacy, we assessed baseline to 12-week changes in daily physical activity level, gait speed, tactile sensitivity, ankle range of motion, DPN symptoms, quality of life, foot health and functionality, foot strength and plantar pressure during gait, using paired t-tests (p < 0.05). In 52 weeks, we recruited 45 eligible participants (0.90/week). Program adherence was 80% and participants’ satisfaction had a mean (SD) of 4.57 (0.70) out of 5. The intervention group significantly improved on toes strength, contact time during gait and DPN symptoms, and peak forefoot pressures increased over time; controls showed significantly increased heel peak pressures and force. The exercise program was feasible, based on a moderate recruitment rate and an adherent and satisfied population, and the intervention showed several positive preliminary effects over time compared to usual care.
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Affiliation(s)
- Renan L. Monteiro
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
- Department of Physical Therapy, Federal University of Amapá, Rod. Juscelino Kubitschek, km 02 - Jardim Marco Zero, Macapá, AP 68903-419, Brazil
| | - Jane S.S.P. Ferreira
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Érica Q. Silva
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Asha Donini
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Ronaldo H. Cruvinel-Júnior
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Jady L. Verissímo
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
| | - Sicco A. Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Isabel C.N. Sacco
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Butantã, São Paulo, SP 05360-000, Brazil; (R.L.M.); (J.S.S.P.F.); (É.Q.S.); (A.D.); (R.H.C.-J.); (J.L.V.)
- Correspondence: ; Tel.: +55-11-3091-8426; Fax: +55-11-3091-7462
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Valerio PM, Gonçalves VE, Zordão CC, Rezende MS, Moisés ECD, Guirro ECDO. Influence of type 1 diabetes on the postural control of women in the third gestational trimester. Clin Biomech (Bristol, Avon) 2020; 77:105062. [PMID: 32497927 DOI: 10.1016/j.clinbiomech.2020.105062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes can cause biomechanical alterations that may be responsible for additional changes to those existing in a regular gestational period. The way a maternal body responds when affected by diabetes has not been clearly understood. This study aimed to describe the influence of type 1 diabetes on pregnant women's postural control. METHODS Forty pregnant women in their third gestational trimester were allocated in two equal groups - the control group and the type 1 diabetic group. The variables related to postural control and balance were assessed using photogrammetry (head protrusion; cervical lordosis; thoracic kyphosis; lumbar lordosis; pelvic anteversion, knee flexion, tibiotarsal and foot inclination angles were measured), and baropodometry (anteroposterior and mediolateral distance trajectory of the center of pressure, amplitude and average speed of displacement of the center of pressure). FINDINGS The results of the type 1 diabetic group showed, in the postural analysis, lower head protrusion and pelvic anteversion angles, while there was higher cervical lordosis, thoracic kyphosis, and lumbar lordosis angles. In the baropodometry, the anteroposterior distance and the amplitude of the center of pressure displacement with eyes open and closed were higher. INTERPRETATION The findings suggest that type 1 diabetes mellitus in the third trimester of pregnancy is associated with postural changes, a decrease in the active ankle range of motion and increase in the anteroposterior oscillation of the center of pressure, with negative repercussions for postural control.
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Affiliation(s)
- Paola Marini Valerio
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, São Paulo CEP: 14049-900, Brazil.
| | - Vanessa Ellen Gonçalves
- Physical Therapy Course, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, São Paulo CEP: 14049-900, Brazil.
| | - Catarina Clapis Zordão
- Physical Therapy Course, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, São Paulo CEP: 14049-900, Brazil.
| | - Monique Silva Rezende
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, São Paulo CEP: 14049-900, Brazil.
| | - Elaine Christine Dantas Moisés
- Postgraduate Program in Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, São Paulo CEP: 14049-900, Brazil.
| | - Elaine Caldeira de Olveira Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, São Paulo CEP: 14049-900, Brazil.
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van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3270. [PMID: 31957213 DOI: 10.1002/dmrr.3270] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022]
Abstract
Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non-controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot-related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight-bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non-existent for the prevention of a first foot ulcer and non-plantar foot ulcer.
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Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS - Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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Bus SA, Lavery LA, Monteiro-Soares M, Rasmussen A, Raspovic A, Sacco ICN, van Netten JJ. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36 Suppl 1:e3269. [PMID: 32176451 DOI: 10.1002/dmrr.3269] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at-risk patient about appropriate foot self-care and treat any pre-ulcerative sign on the foot. Instruct moderate-to-high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non-surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high-risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer-free days, and to reduce the patient and health care burden of diabetic foot disease.
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Affiliation(s)
- Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde and CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
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van Netten JJ, Sacco ICN, Lavery LA, Monteiro-Soares M, Rasmussen A, Raspovic A, Bus SA. Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3271. [PMID: 31957306 DOI: 10.1002/dmrr.3271] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. METHODS The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self-management; pre-ulcer treatment; orthotic interventions; and foot- and mobility-related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre-ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. RESULTS We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self-care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom-made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot- and mobility-related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. CONCLUSIONS Structured education for patients and health care professionals, callus removal, custom-made therapeutic footwear, and foot- and mobility-related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.
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Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Isabel C N Sacco
- Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto, Oporto, Portugal
| | | | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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27
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Silva EQ, Suda EY, Santos DP, Veríssimo JL, Ferreira JSSP, Cruvinel Júnior RH, Monteiro RL, Sartor CD, Sacco ICN. Effect of an educational booklet for prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial II, a study protocol of a randomized controlled trial. Trials 2020; 21:180. [PMID: 32054510 PMCID: PMC7020575 DOI: 10.1186/s13063-020-4115-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background This study is a part of a series of two clinical trials. We consider diabetic polyneuropathy (DPN), a common chronic and progressive complication of diabetes mellitus that has several impacts on individuals’ foot health and quality of life. Based on the current trends of self-monitoring and self-care, providing a tool with foot-related exercises and educational care may help patients to avoid or reduce the musculoskeletal complications resulting from DPN, improving autonomous performance in daily living tasks. The aim of this trial is to evaluate the effects of an educational booklet for foot care and foot muscle strengthening on DPN symptoms and severity, clinical outcomes, and gait biomechanics in patients with DPN. Methods/design The FOotCAre (FOCA) trial II study has been designed as a single-blind, two-parallel-arm randomized controlled trial. It will include 48 patients with DPN who will be randomly allocated to a control (recommended foot care by international consensus with no foot exercises) group or an intervention (foot-related exercises using an educational booklet three times/week at home for 8 weeks) group. Participants from both groups will be assessed at baseline, after 8 weeks, and at 16 weeks for follow-up. The primary outcomes are the DPN symptoms and severity, and the secondary outcomes are foot–ankle kinematics, gait kinetics, plantar pressure distribution during gait, tactile and vibratory sensitivities, foot strength, functional balance, and foot health and functionality. Discussion The booklet is a management tool that allows users to be autonomous in their treatment by choosing how and where to perform the exercises. This allows the patients to perform the exercises regularly as a continuous habit for foot care and health, which is an important element in the management of the diabetic foot. As the booklet focuses on specific foot–ankle exercises, we expect that it will improve the clinical aspects of DPN and produce beneficial biomechanical changes during gait, becoming a powerful self-management tool that can be easily implemented to improve the performance of daily living tasks. Trial registration ClinicalTrials.gov, NCT04008745. Registered on 2 July 2019.
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Affiliation(s)
- E Q Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - E Y Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - D P Santos
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - J L Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - J S S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - R H Cruvinel Júnior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - R L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil.,Department of Physical Therapy, Federal University of Amapá, Macapá, Amapá, Brazil
| | - C D Sartor
- Department of Physical Therapy, Ibirapuera University, São Paulo, São Paulo, Brazil
| | - I C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil.
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28
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Simón-Pérez E, Simón-Pérez C, Alonso-Peña D, Pontón-Cortina A, Chicharro-Luna E, Martínez-Nova A, Navarro-Flores E. Stiffness degree of ankle range of motion in diabetic patients with atypical amputation. Rev Assoc Med Bras (1992) 2020; 66:216-221. [DOI: 10.1590/1806-9282.66.2.216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
SUMMARY In diabetics, foot deformities are risk factors that increase the risk of amputation as a result of developing ulcers. However, knowledge of the influence of plantar stiffness is still limited. The main objective was to describe connections between the degree of stiffness of the ankle, atypical amputation, and the Foot Posture Index (FPI). METHODS 62 diabetic patients, 58 with type 2 and 4 with type 1 (average age 63.35 years) were included. Records of foot deformities were included; A range of motion test of the ankle joint was used to determine the degree of stiffness. An exploratory analysis of the association of foot position and the degree of rigidity was performed. RESULTS The dorsal flexion range of the ankle was 9.6 ± 5.1 0, 13.8 ± 5.9 0 and 17.2 ± 6.5 0 and 20.5 ± 6.8 0 to 45, 67, 89 and 111 N respectively in the amputated feet., And 14 patients (22.58%) had a high level of pronation of IPF with an average value of 3.7 ± 2.629, CI (3.032.-4.367) in amputated feet compared to non-amputees. We use the device “Iowa ankle range of motion” (IAROM) to determine the differences in ankle stiffness. Proper IPF was associated with the presence of amputation and an increase in stiffness CONCLUSIONS There was an increase in the degree of limitation of movement of the ankle, as a greater force was applied. Comparing FPI between the groups, there was a higher frequency of prone feet in the group of amputees
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Ferreira JSSP, Cruvinel Junior RH, Silva EQ, Veríssimo JL, Monteiro RL, Pereira DS, Suda EY, Sartor CD, Sacco ICN. Study protocol for a randomized controlled trial on the effect of the Diabetic Foot Guidance System (SOPeD) for the prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial I. Trials 2020; 21:73. [PMID: 31931855 PMCID: PMC6958734 DOI: 10.1186/s13063-019-4017-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This study is part of a series of two clinical trials. Taking into account the various musculoskeletal alterations of the foot and ankle in people with diabetic peripheral neuropathy (DPN) and the need for self-care to avoid more serious dysfunctions and complications, a self-manageable exercise protocol that focuses on strengthening the foot muscles is presented as a potentially effective preventive method for foot and gait complications. The aim of this trial is to investigate the effect of a customized rehabilitation technology, the Diabetic Foot Guidance System (SOPeD), on DPN status, functional outcomes and gait biomechanics in people with DPN. METHODS/DESIGN Footcare (FOCA) trial I is a randomized, controlled and parallel two-arm trial with blind assessment. A total of 62 patients with DPN will be allocated into either a control group (recommended foot care by international consensus with no foot exercises) or an intervention group (who will perform exercises through SOPeD at home three times a week for 12 weeks). The exercise program will be customized throughout its course by a perceived effort scale reported by the participant after completion of each exercise. The participants will be assessed at three different times (baseline, completion at 12 weeks, and follow-up at 24 weeks) for all outcomes. The primary outcomes will be DPN symptoms and severity classification. The secondary outcomes will be foot-ankle kinematics and kinetic and plantar pressure distribution during gait, tactile and vibration sensitivities, foot health and functionality, foot strength, and functional balance. DISCUSSION As there is no evidence about the efficacy of rehabilitation technology in reducing DPN symptoms and severity or improving biomechanical, clinical, and functional outcomes for people with DPN, this research can contribute substantially to clarifying the therapeutic merits of software interventions. We hope that the use of our application for people with DPN complications will reduce or attenuate the deficits caused by DPN. This rehabilitation technology is freely available, and we intend to introduce it into the public health system in Brazil after demonstrating its effectiveness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.
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Affiliation(s)
- J. S. S. P. Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - R. H. Cruvinel Junior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - E. Q. Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - J. L. Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - R. L. Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
- Department of Physical Therapy, Federal University of Amapá, Amapá, Brazil
| | - D. S. Pereira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - E. Y. Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - C. D. Sartor
- Department of Physical Therapy, Ibirapuera University, São Paulo, SP Brazil
| | - I. C. N. Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
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Gariani K, Waibel FWA, Viehöfer AF, Uçkay I. Plantar Fasciitis in Diabetic Foot Patients: Risk Factors, Pathophysiology, Diagnosis, and Management. Diabetes Metab Syndr Obes 2020; 13:1271-1279. [PMID: 32368120 PMCID: PMC7183784 DOI: 10.2147/dmso.s184259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Plantar fasciitis (PF) is a common degenerative disorder and a frequent cause of heel pain, mostly affecting patients in their fourth and fifth decades. Diabetic patients are particularly at risk due to the presence of common risks and co-morbidities such as obesity or a sedentary lifestyle. The diagnosis of PF is mainly clinical. Imaging is not recommended for the initial approach. The initial management is conservative and should include physiotherapy, off-loading, stretching exercises, and nonsteroidal anti-inflammatory drugs. Glucocorticoid injections or surgery is an option at a later stage in recalcitrant cases. The overall management of PF does not differ between patients with diabetic foot problems and non-diabetic patients, although the details can differ. This narrative review summarizes the state of the art in terms of the risk factors, pathophysiology, diagnosis, assessment, and management of PF in diabetic patients.
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Affiliation(s)
- Karim Gariani
- Service of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals, Geneva, Switzerland
- Correspondence: Karim Gariani Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals, Geneva, Switzerland Email
| | - Felix W A Waibel
- Foot and Ankle Service, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Arnd F Viehöfer
- Foot and Ankle Service, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Ilker Uçkay
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
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Searle A, Spink MJ, Oldmeadow C, Chiu S, Chuter VH. Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: A randomised controlled trial. Clin Biomech (Bristol, Avon) 2019; 69:52-57. [PMID: 31302489 DOI: 10.1016/j.clinbiomech.2019.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/21/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited ankle dorsiflexion, or equinus, is associated with elevated plantar pressures, which have been implicated in the development and non-healing of foot ulcer. A stretching intervention may increase ankle dorsiflexion and reduce plantar pressures in people with diabetes. METHODS Two arm parallel randomised controlled trial from September 2016 to October 2017. Adults with diabetes and ankle equinus (≤5° dorsiflexion) were randomly allocated to receive an 8 week static calf stretching intervention or continue with their normal activities. Primary outcome measures were change in weight bearing and non-weight bearing ankle dorsiflexion and forefoot peak plantar pressure. Secondary outcome measures were forefoot pressure time integrals and adherence to the stretching intervention. FINDINGS 68 adults (mean (standard deviation) age and diabetes duration 67.4 (10.9) years and 14.0 (10.8) years, 64.7% male) were randomised to stretch (n = 34) or usual activity (n = 34). At follow up, no significant differences were seen between groups (adjusted mean difference) for non-weight (+1.3°, 95% CI:-0.3 to 2.9, p = 0.101) and weight bearing ankle dorsiflexion (+0.5°, 95% CI:-2.6 to 3.6, p = 0.743) or forefoot in-shoe (+1.5 kPa, 95% CI:-10.0 to 12.9, p = 0.803) or barefoot peak pressures (-19.1 kPa, 95% CI:-96.4 to 58.1, p = 0.628). Seven of the intervention group and two of the control group were lost to follow up. INTERPRETATION Our data failed to show a statistically significant or clinically meaningful effect of static calf muscle stretching on ankle range of motion, or plantar pressures, in people with diabetes and ankle equinus.
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Affiliation(s)
- Angela Searle
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia.
| | - Martin J Spink
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia
| | | | - Simon Chiu
- Hunter Medical Research Institute, Newcastle, Australia
| | - Vivienne H Chuter
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia; School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Australia
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Ferreira JSSP, Sacco ICN, Siqueira AA, Almeida MHM, Sartor CD. Rehabilitation technology for self-care: Customised foot and ankle exercise software for people with diabetes. PLoS One 2019; 14:e0218560. [PMID: 31220155 PMCID: PMC6586406 DOI: 10.1371/journal.pone.0218560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS To develop and validate the content of a free web-based software (desktop and mobile applications) for the self-management of and customised foot-ankle exercises for people with diabetes and diabetic neuropathy. METHODS The development of the programme was based on gamification principles and addressed three main areas: foot care recommendations; self-assessment of feet according to the main complications of diabetic neuropathy; and customised foot-ankle exercises to strengthen muscles, increase the range of motion and improve functionality. The content was validated using the Delphi methodology and a quantitative approach in two rounds with diabetes specialists (n = 9) and users with diabetes (n = 20). A 70% approval rate was considered sufficient in the second round for final validation purposes. The data analysis was conducted using descriptive statistics, absolute and relative frequencies and the content-validity index (CVI). RESULTS Among specialists, the CVI was 0.812 after the first round, and final approval was 100% after the second round. Among users, the CVI was 0.902 in the first round, and the final approval was 97%. CONCLUSION This free access web software was developed based on the high agreement rating between specialists and users and has the potential to prevent complications arising from diabetic polyneuropathy. It allows for self-monitoring and promotes personalised exercises, following a preventive model that can be applied in primary and secondary care services as a complementary treatment for chronic complications. However, further steps to validate the software in a larger population are recommended.
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Affiliation(s)
- Jane S. S. P. Ferreira
- Departamento Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Isabel C. N. Sacco
- Departamento Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Maria H. M. Almeida
- Departamento Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Cristina D. Sartor
- Departamento Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Universidade Ibirapuera, São Paulo, São Paulo, Brazil
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Subrata SA, Phuphaibul R. A nursing metaparadigm perspective of diabetic foot ulcer care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S38-S50. [PMID: 30925236 DOI: 10.12968/bjon.2019.28.6.s38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.
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Affiliation(s)
- Sumarno Adi Subrata
- PhD Candidate, Doctor of Philosophy Program in Nursing, International and Collaborative with Foreign University Program, Mahidol University, Thailand; and Nursing Lecturer, Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
| | - Rutja Phuphaibul
- Professor of Nursing, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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Telfer S, Bigham JJ. The influence of population characteristics and measurement system on barefoot plantar pressures: A systematic review and meta-regression analysis. Gait Posture 2019; 67:269-276. [PMID: 30391749 DOI: 10.1016/j.gaitpost.2018.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/17/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results. METHODS A systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI. RESULTS 115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns. CONCLUSIONS At the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable.
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Affiliation(s)
- S Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States.
| | - J J Bigham
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
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Francia P, Anichini R, Seghieri G, De Bellis A, Gulisano M. History, Prevalence and Assessment of Limited Joint Mobility, from Stiff Hand Syndrome to Diabetic Foot Ulcer Prevention: A Narrative Review of the Literature. Curr Diabetes Rev 2018; 14:411-426. [PMID: 28814244 PMCID: PMC6343166 DOI: 10.2174/1573399813666170816142731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Limited Joint Mobility (LJM) is a dreaded complication of Diabetes Mellitus (DM). During the last half century, LJM has been studied in patients of different age because it has been considered useful for the monitoring of a patient's condition and for the prevention of vascular disease and diabetic foot. OBJECTIVES The main aims of this review are to describe the relationship between DM and joint mobility as well as its prevalence and assessment. We have also investigated the role of LJM in the development of diabetic foot ulcers. METHODOLOGY An in-depth literature search was conducted to identify studies that examined the prevalence and characteristics of LJM in patients with DM of different types, age, durations and chronic complications. RESULTS Many factors (therapy improvements, population characteristics and different evaluation methods) concur to hinder an exact assessment of the prevalence of LJM. However, it has been confirmed that LJM is widespread among patients with DM and may affect more than two-thirds of them in addition to being a major risk factor for foot ulcer. Its role in the monitoring of a patient's condition is also important for the definition of risk thresholds such as in patients with diabetic foot. The efficacy of exercise therapy for the treatment of LJM, also in patients at risk of foot ulcer, has not been discussed. CONCLUSION Difficulties encountered in the definition of the prevalence of LJM may hinder its study and the establishment of preventive interventions. However, LJM plays a key role in the monitoring of patients, especially those at risk for ulcer.
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Affiliation(s)
- Piergiorgio Francia
- Address correspondence to this author at the Department of Experimental and Clinical, Medicine, University of Florence, Largo Brambilla, 3 - 50134 Florence, Italy; Tel/Fax: +39 0552758050;, E-mail:
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Searle A, Spink MJ, Ho A, Chuter VH. Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2017; 43:8-14. [PMID: 28167343 DOI: 10.1016/j.clinbiomech.2017.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/20/2016] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is one of the most common chronic diseases in the world and is associated with a life-time risk of foot ulcer of 12-25%. Diabetes related restriction in ankle joint range of dorsiflexion is proposed to contribute to elevated plantar pressures implicated in the development of foot ulcers. METHODS A systematic search of EBSCO Megafile Premier (containing MEDLINE, CINAHL, SPORTSdiscus and Academic Search Complete) and The Cochrane Library was conducted to 23rd November 2016. Two authors independently reviewed and selected relevant studies. Meta-analysis of study data were conducted where possible. FINDINGS Fifteen studies met the inclusion criteria. Three studies were eligible to be included in the meta-analysis which found that equinus has a significant, but small, effect on increased plantar pressures (ES=0.26, CI 95% 0.11 to 0.41, p=0.001). Of the remaining studies, eight found evidence of an association between limited ankle dorsiflexion and increased plantar pressures while four studies found no relationship. INTERPRETATION Limited ankle joint dorsiflexion may be an important factor in elevating plantar pressures, independent of neuropathy. Limited ankle dorsiflexion and increased plantar pressures were found in all the studies where the sample population had a history of neuropathic foot ulceration. In contrast, the same association was not found in those studies where the population had neuropathy and no history of foot ulcer. Routine screening for limited ankle dorsiflexion range of motion in the diabetic population would allow for early provision of conservative treatment options to reduce plantar pressures and lessen ulcer risk.
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Affiliation(s)
- A Searle
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia.
| | - M J Spink
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia
| | - A Ho
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Australia
| | - V H Chuter
- School of Health Sciences, Faculty of Health, University of Newcastle, Australia
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