Preventing Foot Injuries In Diabetic Athletes

Author(s): 
By Mark A. Caselli, DPM

Exercise plays an important role in the management of both insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM). Regular exercise, especially aerobic exercise, strengthens the heart and circulatory system, thus reducing the chance of heart disease and stroke. It helps decrease blood cholesterol and increases the levels of the “good” high-density lipoprotein (HDL) in the blood. Exercise lowers blood glucose levels, both during exercise and for several hours afterward.
Walking is probably the best, safest and least expensive form of exercise. It can fit into almost anyone’s schedule and can be integrated into other events and activities. The only investment needed is a comfortable pair of appropriate shoes. However, many people prefer to jog or run. This yields a more intense workout in less time. It also can be associated with organized competitive activities such as marathons and often results in a much greater feeling of accomplishment and self-satisfaction.

Unfortunately, running can lead to many types of foot and leg injuries. When it comes to the average recreational runner who trains regularly and takes occasional long distance runs, the injury rate is somewhere between 37 and 56 percent. One must recognize the factors that contribute to these injuries, especially when you’re treating diabetic athletes who are at increased risk.
Fifty to 75 percent of all running injuries are from overuse injuries, which usually result in muscle strains, such as plantar fasciitis and shin splints. Some of the biomechanical factors, which can lead to these overuse injuries, include leg length discrepancy, flexibility problems, muscle weakness or imbalance and laxity of ligaments. Training errors are the most common cause of overuse injuries. Training errors include excess mileage, a change in training patterns, improper footwear or troubles with the training surfaces.
In addition to these problems, the presence of diabetes also appears to result in the increased prevalence of pedal fractures in the athlete. A study comparing the incidence of pedal fractures in 60 diabetic athletes with 60 non-diabetic athletes revealed a two-fold increase in the number of diabetics sustaining fractures with the most frequently fractured bones being the second, third and fifth metatarsals. The diabetic athlete group also sustained more multiple foot fractures.

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