Should Patients With Diabetic Peripheral Neuropathy Do Weightbearing Exercise?

David G. Armstrong DPM MD PhD

Podiatric physicians can face a dilemma of whether patients with diabetic peripheral neuropathy can exercise due to insensitive feet. A recent study in The Foot says neuropathic patients can participate in some monitored exercise.1

The study focused on 15 patients with diabetic peripheral neuropathy. Researchers recorded peak plantar pressures in the forefoot, midfoot and heel during level walking and compared those pressures to weightbearing and non-weightbearing exercises. Weightbearing exercises included treadmill walking, heel and toe raises, sit to stands, stair climbing and single leg standing. Non-weightbearing exercises were stationary bicycling, balance ball exercise and plantarflexion exercise.

In comparison to level walking, the authors noted that mean forefoot peak plantar pressures during treadmill walking were 13 percent higher. However, they note this difference was eliminated when using walking speed as a covariate. The study researchers added that mean peak plantar pressures were similar or substantially lower for other exercises with the exception of higher forefoot peak plantar pressures during heel raise exercises.

The study authors recommend slow progression and regular monitoring of insensitive feet for all exercises, especially for heel raises and increases in walking speed. They noted that the remaining weightbearing and non-weightbearing exercises in the study pose “no greater risk to the insensitive foot due to increases in peak plantar pressures compared to level walking.”

I think the highest risk patients with diabetic peripheral neuropathy will be most problematic and therefore will require the most attention during exercise. We believe strongly that marrying these types of programs with advances in mobile health (mHealth) and home monitoring of complications will make this kind of program the rule rather than the exception. At SALSA, we are actively pursuing these programs both in research projects and chairside with our patients.

Here’s the bottom line: walking, stair climbing, sit to stands, cycling and balance ball training do not significantly increase plantar pressure in our high-risk patients. Accordingly, let us consider monitored exercise programs for these patients.

Reference

1. Shah KM, Mueller MJ. Effect of selected exercises on in-shoe plantar pressures in people with diabetes and peripheral neuropathy. Foot (Edinb). 2012; 22(3):130-4.

This blog has been adapted with permission from a blog that previously appeared at http://www.diabeticfootonline.blogspot.com/2013/02/can-my-patient-with-d... .

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