Diabetic foot care within the context of rehabilitation: keeping people with diabetic neuropathy on their feet. A narrative review

Abstract

Background

A large percentage of patients with diabetes mellitus have neuropathy putting them at risk of developing severe foot problems. In diabetic foot care the primary objective is to prevent foot ulceration and avoid loss of limb. The role of physical therapy in diabetic foot care remains insufficiently defined. This narrative review discusses principles of diabetic foot care and implications for rehabilitation.

Objectives

The objectives are to review:

•	which aspects of current diabetic foot care are relevant for rehabilitation.
•	how and where physical therapy expertise can contribute to diabetic foot care.
•	how physical therapy can safely design an exercise programme when patients have diabetic neuropathy.

Major findings

The diabetic foot is a complex condition. Current best practice involves care by a multi-disciplinary team. Physical therapy should adhere to key elements of foot ulcer prevention. The effect of reduced balance and mobility resulting from foot ulceration and its treatment indicates a need for bespoke exercise programs. During full weight-bearing exercises protective footwear should be worn at all times. Furthermore, a good understanding of the impact of functional exercises used in rehabilitation with respect to plantar pressure and postural control needs to ensure that exercise prescription is appropriately targeted and safe.

Conclusions

Physical therapy can make a considerable contribution to overall management of patients with diabetic neuropathy. A tailored exercise programme to improve fitness, strength, range of motion, balance and mobility should be aimed primarily at keeping patients with diabetic neuropathy safely on their feet and improve clinical outcomes.

Keywords:

• diabetic foot
• foot ulceration
• plantar pressure
• rehabilitation
• physical therapy