Diabetic Foot and Exercise Therapy: Step by Step The Role of Rigid Posture and Biomechanics Treatment

Abstract

Lower extremity ulcers represent a serious and costly complication of diabetes mellitus. Many factors contribute to the development of diabetic foot. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute in turn to the growth of additional risk factors such as limited joint mobility, muscular alterations and foot deformities. Moreover, a deficit of balance, posture and biomechanics can be present, in particular in patients at high risk for ulceration. The result of this process may be the development of a vicious cycle which leads to abnormal distribution of the foot's plantar pressures in static and dynamic postural conditions.This review shows that some of these risk factors significantly improve after a few weeks of exercise therapy (ET) intervention. Accordingly it has been suggested that ET can be an important weapon in the prevention of foot ulcer.The aim of ET can relate to one or more alterations typically found in diabetic patients, although greater attention should be paid to the evaluation and possible correction of body balance, rigid posture and biomechanics. Some of the most important limitations of ET are difficult access to therapy, patient compliance and the transitoriness of the results if the training stops. Many proposals have been made to overcome such limitations. In particular, it is important that specialized centers offer the opportunity to participate in ET and during the treatment the team should work to change the patient’s lifestyle by improving the execution of appropriate daily physical activity.

Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship?

“…These results confirm that diabetes can induce alterations of connective and muscle tissues in the lower limb and foot. Among these, the effects of diabetes on the Achilles tendon and plantar fascia are particularly marked and they can induce an even stiffer feet posture in an even more plantar flexion . It is known that these alterations over time lead to gait abnormalities and the development of deformities.…”

“…It has been reported that in adults, the abnormal use of joints, as in the case of an altered gait biomechanics or the lack of movement, can play a role in the development of LJM …”

“…In particular, ankle ROM can be significantly affected by diabetes. Studying ankle ROM in young T1D patients can be important because its deficit can affect the quality of gait and posture, in addition to the motor and postural development of young patients …”

“…9,14 It has been reported that in adults, the abnormal use of joints, as in the case of an altered gait biomechanics or the lack of movement, can play a role in the development of LJM. [15][16][17][18][19] On the contrary, it has been shown that just a few weeks of exercise training program can improve joint mobility in patients with diabetes. [20][21][22][23] Even in young subjects it has been suggested that lifestyle and sports practiced can modify their LJM.…”

“…Studying ankle ROM in young T1D patients can be important because its deficit can affect the quality of gait and posture, in addition to the motor and postural development of young patients. 16,[27][28][29] The aims of this study were to verify the presence of ankle LJM in both plantar and dorsiflexion in young T1D patients and determine the possible role of sport practiced on AJM deficits.…”