Diabetic foot and exercise therapy

1. Diabetic foot and exercise
therapy

2. Diabetic Foot
• Diabetic foot ranges from foot at risk to frank gangrene
• A constellation of physical findings and medical complications in the
foot, arising as a consequence of
• Impaired sensation due to diabetic neuropathy (80 – 90%)
• Impaired blood supply due to peripheral vascular diseases (30-40%)
• Foot deformities
• Trauma
• Management of diabetic foot is multi-disciplinary

3. Diabetic foot classification
• Neuropathic foot with palpable pulses
• Foot with neuropathic ulceration
• Charcot foot, which may be secondarily complicated by ulceration
• Ischaemic foot without pulses and a varying degree of neuropathy
• Neuroischaemic foot characterized by both ischemia and neuropathy and
complicated by ulcer
• Critically ischaemic foot
• Acutely ischaemic foot
• Renal ischaemic foot characterized by digital necrosis

4. Wagner’s classification
• Stage 0 = Foot at risk
• Stage 1 = Superficial ulcer/blister
• Stage 2 = Deep ulcers
• Stage 3 =Deep ulcer with abscess, osteomyelitis,
• Stage 4 = Fore-foot gangrene
• Stage 5 = Hind-foot gangrene

6. Exercise therapy and etiological factors of
diabetic foot
• Main etiological factors (individually or altogether)
• Neuropathy
• Vasculopathy
• Foot deformities
• Trauma
• Other factors
• limited joint mobility (LJM)
• Muscle weakness
• Poor balance
• Posture and gait alterations

7. Peripheral neuropathy
• Regular physical activity and aerobic and resistance exercise training
• Reducing risk of developing neuropathy
• Reduces body weight
• Improves blood glucose control and insulin sensitivity
• Promoting microvascular function and fat oxidation by
• Reducing oxidative stress
• Increasing neurotrophic factors

8. Peripheral arterial disease
• The positive effects of ET in in diabetic patients with PAD
• Improvement in
• Endothelial function,
• Oxidative stress,
• Markers of adiposity (Body composition)
• Inflammatory responses
• Perfusion and plasma viscosity
• Facilitating oxygen delivery, skeletal muscle metabolism and strength

9. Joint mobility and Muscular dysfunction
• Pattern of dysfunction
• Plantar Fascia and Achilles Tendon
• Limited Joint Mobility
• Weak and elongated muscles
• Stretching and joint mobilization
• Reduce arch deformation, excessive pronation, rearfoot valgus, and improve
ankle dorsiflexion and PF tension
• Muscular dysfunction
• Muscle strength, power and performance

10. Balance, Posture and Gait
• POSTURE, BALANCE AND GAIT
• Improving and maintaining the foot’s biomechanics result in restoring a
physiological pattern
• Improving proprioception
• PLANTAR PRESSURE
• No positive direct effect on foot plantar pressure
• indirectly., improve the quality of PP distribution
• Improving functional deficit
• Improving static and dynamic posture alterations
• Reduce weight loss

11. Exercise treatment
• Wagner grade 1 or 2 DFU
• Type of exercises
• Range of joint motion,
• Stretching exercises,
• Strengthening exercises,
• Proprioception and balance exercises

12. The role of exercise therapy in the prevention
and/or treatment of diabetic foot

13. Shortcomings in exercise therapy
• Patient compliance
• Therapist shortcomings
• Patient consultation.

14. Conclusion
• Multi-disciplinary approach needed
• Going to be an increasing problem
• High morbidity and cost
• Solution is probably in prevention
• Most feet can be spared…at least for a while