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Walking performance in people with diabetic neuropathy: benefits and threats. Diabetologia. 2006 Jun 7;
Quote:
AIMS/HYPOTHESIS: Walking is recommended as an adjunct therapy to diet and medication in diabetic patients, with the aim of improving physical fitness, glycaemic control and body weight reduction. Therefore we evaluated walking activity on the basis of capacity, performance and potential risk of plantar injury in the diabetic population before it can be prescribed safely.
SUBJECTS, MATERIALS AND METHODS: Twenty-three subjects with diabetic neuropathy (DMPN) were compared with 23 patients with current diabetic foot ulcers, 16 patients with partial foot amputations and 22 patients with trans-tibial amputations. The capacity for walking was measured using a total heart beat index (THBI). Gait velocity and average daily strides were measured to assess the performance of walking, and its impact on weight-bearing was studied using maximum peak pressure.
RESULTS: THBI increased (p<0.01) and gait velocity and daily stride count fell (p<0.001 for both) with progression of foot complications. The maximum peak pressures over the affected foot of patients with diabetic foot ulcers (p<0.05) and partial foot amputations (p<0.01) were higher than in the group with DMPN. On the contralateral side, the diabetic foot ulcer group showed higher maximum peak pressure over the total foot (p<0.05), and patients with partial foot amputations (p<0.01) and trans-tibial amputations (p<0.05) showed higher maximum peak pressure over the heel.
CONCLUSIONS/INTERPRETATION: Walking capacity and performance decrease with progression of foot complications. Although walking is recommended to improve fitness, it cannot be prescribed in isolation, considering the increased risk of plantar injury. For essential walking we therefore recommend the use of protective footwear. Walking exercise should be supplemented by partial or non-weight-bearing exercises to improve physical fitness in diabetic populations.
About ~7-8 years ago I was on a panel as part of a diabetes and exercise session at a sports medicine conference. I was the last one to speak -- all the rest of the panel (diabetes physcian; dietitian; exercise physiologist) all gave glowing reports on the benefits of exercise etc etc for those with diabetes.... I then got up and talked about the increased risk for stress fractures; the dangers of weightbearing activity on the neuropathic foot; the biomechanical consequences of LJM; etc .... talk about giving them the bad news...
I also recall either some data or a comment from a while back that there is an increase in lower limb amputation in those who have had a renal transplant purely because of the increased acticity levels that follow the surgey (no more sitting around all day on dialysis) .... so that research above does make sense and contains a cautionary tale we all should be aware of.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Craig,
Another reason for the increase in amputation in Renal transplant patients with diabetes is the fact that they usually have severe ischaemia, and are often too ill to have reconstructive surgery. The transplant surgery can often throw off emboli which then block off pedal ateries as well. All in all not a good combination to have !
I am always at aloose end to understand a diseasemanagment approach which relies so heavily upon self care which involves exercise as part of prevention and or rehabilitation,yet singularly ignores the importance of footwear.I think it is close to abdication of a duty of care
Cameron,
I absolutely and wholeheartedly agree with you.
I have seen far too many feet damaged by footwear after patients have been told by well meaning Drs and nurses to take more exercise, without giving any note or information about footwear or even footcare! Just telling patients to wear training shoes would help, nut even this isnt done in the majority of cases.
Feet just arent sexy enough ! and are therefore ignored, even though the associated costs (both directly and indirectly ) are huge.
Diabetic foot complications and walking performance
Linear Mode
