PHYSIOTHERAPY FOR DIABETIC FOOT

PHYSIOTHERAPY FOR DIABETIC FOOT

Clinical Assessment

Inspection: Dermatologic

• Skin status: colour, thickness, dryness, cracking; • Sweating
• Infection: check between toes for fungal infection; • Ulceration
• Calluses/blistering: hemorrhage into callus?

Musculoskeletal

• Foot deformity (claw toe, hammer toe, Charcot joint)
• muscle wasting (guttering between metatarsals)
• passive and active ankle ROM and first metatarsophalangeal joints in the sagittal plane
• Intrinsic and extrinsic foot and ankle muscle functions (power)
• Foot function
• confidence in performing daily locomotor skills
• Biomechanical assessment (gait plantar pressure distribution, gait kinetics, gait kinematics)

Neurological assessment: 10-g monofilament and pinprick sensation

Vascular assessment: foot pulses

Intervention rationale

This intervention protocol is based on evidence that shows that:

1. Foot rigidity is associated with increasing local loads and predisposes to plantar ulceration. The increase in ROM of these segments could contribute to restoring foot rollover during gait.
2. The weakness of the intrinsic foot muscles and ankle flexors and extensors represents an independent risk factor for the development of plantar ulcers, leading to a less effective plantar load distribution. The strengthening and recovery of their function also could be reflected in foot rollover during gait.
3. There is evidence that shows that patients with diabetic peripheral neuropathy (DPN) can improve gait and confidence, suggesting a possible recovery of motor control functions at some level. A more comprehensive exercise therapy should integrate the peripheral gains (increase in ROM and muscle function and strength) into motor tasks, such as gait. It could be achieved when requiring these gains during the execution of walking skills and simple balance exercises.
4. The patients should perform the exercises independently at home, and the exercises should be simple enough to allow that.

Therapeutic Exercises (see table 1): These are to achieve

1. Increase of ROM
2. Strengthening the muscles
3. To improve rollover during gait
4. To improve motor control function
5. To improve venous return

Therapeutic Exercises for Fall and Balance Outcome (see Appendix).

 

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