Can walking speed be improved with foot-ankle therapeutic exercises in patients with diabetic nerve disease?

This study investigated the effects of foot-ankle therapeutic exercises on daily physical activity and gait (walking) speed in people with diabetic peripheral neuropathy (DPN). The data showed that at 12 weeks, these exercises led to improvements in fast walking speeds and quality of life compared to usual care.

Diabetic peripheral neuropathy (DPN) involves nerve damage due to consistently high levels of blood glucose in patients with diabetes. DPN can result in decreased feeling in the hands and feet, limb amputations, decreased physical movements, reduced physical activity, and lowered muscle strength. If physical activity is affected, the range of motion (ROM) of the foot-ankle and walking speed can be reduced. As a result, patients often experience reduced quality of life (QoL).

Exercise therapy strategies that focus on foot and mobility exercises may increase ROM and improve symptoms of DPN. However, their effectiveness in improving foot-ankle muscle strength and increasing the ability of patients to perform daily functions remains unclear.

This study included 78 patients with DPN. Patients were randomly assigned to either a control group (CG; 39 participants) or an intervention group (IG; 39 participants). Patients in the CG received usual care and those in the IG received a 12-week foot-ankle exercise program and usual care. Usual care consisted of daily feet inspection, use of socks without elastic and seams, proper cutting of toenails, absence of cutting of corns or blisters without supervision, avoidance of going barefoot or wearing slippers or shoes without socks, and seeking medical help if foot issues were identified. Patients were assessed on the number of steps (daily physical activity), self-selected gait, and fast-gait speeds. The follow-up time was 1 year.

At 12 weeks, fast-gait speed was significantly improved in the IG compared to usual care alone. There were also improvements in foot-ankle ROM, vibration sensitivity, and QoL. At 24 weeks, QoL was improved in the IG compared to usual care. At 1 year, there was a step difference of 1,365 steps between the groups. There was also a better vibration perception at 1 year in the IG group compared to the CG.

The study showed that foot-ankle exercises may be an effective complementary treatment to usual care for patients with DPN.

The study did not consider exercise intensity. The patient drop-out rate was relatively high. Blood glucose levels and HbA1c were not measured and may have influenced results.