How beneficial are foot-ankle flexibility and resistance exercises for preventing foot diabetic ulcer recurrence?

This study assessed the effect of foot-ankle flexibility and resistance exercises in the prevention and recurrence of plantar foot-diabetic ulcers. The authors concluded that foot-ankle flexibility and resistance exercises can reduce the recurrence of plantar foot-diabetic ulcers and improve diabetic neuropathy (DN; nerve damage) and walking speed.

A diabetic foot ulcer is an open wound that commonly occurs on the plantar region (bottom) of the feet of patients with diabetes. Multiple factors can contribute to foot ulcer ocurrence such as DN (nerve damage caused by high blood glucose, measured by diabetic neuropathy examination or DNE scores), peripheral arterial disease (PAD; reduced blood flow to limbs due to narrowed arteries, measured by the ankle-brachial index or ABI).

An inadequate control of blood glucose based on high HbA1c levels (average blood glucose over the past 2 to 3 months) usually leads to DN. Foot exercises have been shown to decrease diabetic foot ulcer risk factors. However, the role of foot exercises in plantar foot diabetic ulcer reappearance remains unclear.

This study included 50 patients with diabetes. Patients had plantar diabetic foot ulcers that had healed recently (less than 12 months). 25 patients were placed into an intervention group (group 1). They performed foot-ankle flexibility and resistance exercises three times weekly using elastic bands. 25 patients were assigned to a control group and exercises were not performed (group 2). Both groups received foot care education. Plantar foot diabetic ulcer recurrence was assessed at 12 weeks, 24 weeks, or earlier.

2 patients (4%) in the intervention group had ulceration recurrence compared to 17 patients (68%) in the control group, within 12 weeks. 4 patients (16%) in the intervention group had ulceration recurrence compared to 18 patients (72%) in the control group, within 24 weeks.

There was a significant decrease in the average DNE score and an increase in average walking speed at 12 weeks and 24 weeks for the intervention group.

The data suggested that foot-ankle flexibility and resistance exercise can prevent plantar foot diabetic ulcer recurrence.

The study did not consider differences in medication and diet between both groups. Data was incomplete for 6 patients.