Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?

Abstract

One of the most common and serious complications of diabetes mellitus is ulceration of the foot. Among persons with diabetes, 12%-25% will present to a healthcare institution for a foot disorder during their lifespan. Despite currently available medical and surgical treatments, these are still the most common diabetes-related cause of hospitalization and of lower extremity amputations. Thus, many adjunctive and complementary treatments have been developed in an attempt to improve outcomes. We herein review the available literature on the effectiveness of several treatments, including superficial and deep heaters, electro-therapy procedures, prophylactic methods, exercise and shoe modifications, on diabetic foot wounds. Overall, although physical therapy modalities seem to be useful in the treatment of diabetic foot wounds, further randomized clinical studies are required.

Diabetic foot infections: what have we learned in the last 30 years?

“…154 Employing other forms of physical therapy and rehabilitation may also help improve the outcomes of DFI. 155…”

Evaluation of Dermatological Findings in Diabetic Foot Syndrome

“…İnfekte ya da iskemik diyabetik ayak ülser sorunları ise diyabet hastaları için tüm hastanede kalış sürelerinin yaklaşık %20'sini kapsar [26] . Diyabetli hastalarda ayak ülserlerine neden olan ana faktörler mikro ve makrovasküler hasar, nöropati ve eklem hareket kısıtlılığı olup aşırı basınç, ayak deformitesi, kallus, travma, infeksiyon gibi diğer etkenleri de içerir [28,29] . Diyabetik ayak ülseri tedavi yönetiminde ilk adım ülseri sınıflandırmaktır.…”

“…Bu durum; ayakta kemer (ark) değişikliklerine yol açan kas ve eklem gevşekliğinden sorumlu motor, otonomik ve duyusal nöropatinin kombinasyonu sonucu ortaya çıkar [37] . Bu deformiteler ayağın mimari yapısını bozar ve belli noktalarda üzerine aşırı basınç yüklenmesine ve ülser riskinin artmasına yol açar [28] . Diyabetli 398 hastada yapılan bir çalışmada %23.9 hastada halluks valgus, %46.7 hastada çekiç parmak deformitesi ve %24.4 hastada ayak birinci parmakta eklem kısıtlılığı olarak tanımlanan halluks limitus saptanmıştır [38] .…”

Effectiveness Combination of Foot Care with Active Range of Motion (ROM) and Plantar Exercise for Reducing Diabetic Foot Ulcer Risk in Diabetes Mellitus Type II

“…The reduction of DFU risk on the intervention group was higher (40.1%) than the control group (14.3%). Some literature said that active ROM on diabetic foot could minimalize DFU risk because it could maintain the joint's mobility and prevent muscle's deformity and atrophy [16]. Active ROM method covers the movement of lower side joints, including hips joint, knees, ankles, and also the condyloid radius of the foot [17].…”

“…This combination could stimulate the foot's muscles to contract and compress blood's vessels to increase blood's supplies to peripheral tissues [18]. It causes more open capillary nets and more insulin receptors available and active to facilitate blood glucose entry into cells, so the blood glucose level was decreased and reduce the risk of DFU complications [16,19]. The daily foot care could decrease DFU risk significantly, but the combination of daily foot care with ROM and plantar exercise could decrease 40.1 % higher than daily foot care itself (14.3%).…”