Diabetic foot results from neuropathy, vascular disease, foot deformities, and trauma which impair sensation and blood flow. It ranges from feet at risk to gangrene. Exercise therapy can help prevent and treat diabetic foot by reducing neuropathy and vascular disease risks, improving joint mobility and muscle strength, and enhancing balance and gait. A multi-disciplinary approach including exercises is needed to manage diabetic foot given its increasing problem and high costs, with the goal of prevention to spare feet for as long as possible.

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