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Cited by 179Diabetic Foot Ulcer Assessment and ManagementFoot and Ankle SurgerySkin Diseases and Diabetes

Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial

LeMaster, Joseph W, Mueller, Michael J, Reiber, Gayle E, Mehr, David R, Madsen, Richard W, Conn, Vicki S·2008·Physical Therapy
DOI 10.2522/ptj.20080019
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Abstract

Background: Weight-bearing exercise has been contraindicated among people with diabetic peripheral neuropathy (DM+PN). However, recent cohort studies have suggested that daily weight-bearing activity is associated with lower risk for foot ulceration. Objective: The objective of this study was to determine the effect of a lower-extremity exercise and walking intervention program on weight-bearing activity and foot ulcer incidence in people with DM+PN. Design: This was an observer-blinded, 12-month randomized controlled trial. Setting: The settings were physical therapy offices in part 1 of the intervention and the community in part 2 of the intervention. Participants: The participants were 79 individuals with DM+PN who were randomly assigned either to a control group (n=38) or an intervention group (n=41) group. Intervention: Intervention components included leg strengthening and balance exercises; a graduated, self-monitored walking program (part 1); and motivational telephone calls every 2 weeks (part 2). Both groups received diabetic foot care education, regular foot care, and 8 sessions with a physical therapist. Measurements: Total and exercise bout–related daily steps at baseline and at 3, 6, and 12 months were measured by accelerometers. Foot lesions/ulcers were photographed and classified by an independent panel of dermatologists. Use of adequate footwear was monitored. Results: At 6 months, bout-related daily steps increased 14% from baseline in the intervention group and decreased 6% from baseline in the control group. Although the groups did not differ statistically in the change in total daily steps, at 12 months steps had decreased by 13% in the control group. Foot ulcer rates did not differ significantly between groups. Conclusion: Promoting weight-bearing activity did not lead to significant increases in foot ulcers. Weight-bearing activity can be considered following adequate assessment and counseling of patients with DM+PN.

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  • Moderate walking does not increase risk of foot ulcers or reulceration in those with peripheral neuropathy.

    “However, recent studies indicated that moderate walking does not increase risk of foot ulcers or reulceration in those with peripheral neuropathy ( 166 , 167 ).”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [166]

    The Discussion (page not supplied) says the trial found no evidence that weight-bearing activity increased foot-ulcer risk, and it reports an earlier finding of lower reulceration risk among more active people with prior ulcers. But the authors caution that the trial’s wide confidence intervals cannot exclude a clinically important difference. The unqualified claim that moderate walking does not increase either risk is stronger than the evidence, which concerns people with diabetic peripheral neuropathy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Up to 40% of diabetic individuals may experience peripheral neuropathy, and 60% of lower extremity amputations in Americans are related to diabetes.

    “Up to 40% of diabetic individuals may experience peripheral neuropathy, and 60% of lower extremity amputations in Americans are related to diabetes ( 166 , 199 , 216 ).”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [166]

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1 of the 65 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. [3]3. Palumbo PJ, Melton LJ III. Peripheral vas- cular disease and diabetes. In: National Di- abetes Data Group, National Institute of Diabetes and Digestive and Kidney Dis- eases, eds. Diabetes in America. 2nd ed. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995: 401-408.
  2. [36]36. Kervio G, Ville NS, Leclercq C, et al. Inten- sity and daily reliability of the six-minute walk test in moderate chronic heart failure patients. Arch Phys Med Rehabil. 2004; 85:1513-1518.
  3. [37]37. Pankoff BA, Overend TJ, Lucy SD, White KP. Reliability of the six-minute walk test in people with fibromyalgia. Arthritis Care Res. 2000;13:291-295.
  4. [50]50. del Aguila MA. Assessment of Physical Ac- tivity in Patients With Diabetes (Lower Extremities, DPAQ, Test Reliablity) [PhD dissertation]. Seattle, WA: University of Washington-Seattle; 1998.

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Authors
LeMaster, J. W., Mueller, M. J., Reiber, G. E., Mehr, D. R., Madsen, R. W., & Conn, V. S.
Affiliations
  • University of Missouri (US)
  • Washington University in St. Louis (US)
  • University of Washington (US)
Corresponding author
LeMaster, Joseph W
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2008-11-01
Volume
88
Issue
11
Pages
1385-1398
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.2522/ptj.20080019
OpenAlex
W2156270298
Cited by
179
References
65
Citations by year
2026: 4 · 2025: 8 · 2024: 6 · 2023: 13 · 2022: 10 · 2021: 20 · 2020: 11 · 2019: 8 · 2018: 9 · 2017: 5 · 2016: 18 · 2015: 9 · 2014: 8 · 2013: 12 · 2012: 9
FWCI
7.00
Type
journal article
Language
en
Open access
closed
Locations
  • Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
  • Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
Keywords
diabetic peripheral neuropathy, diabetic foot ulcer, weight-bearing exercise, walking intervention, leg exercise, balance training, daily step count, footwear, foot care education
MeSH terms
Aged, Diabetic Neuropathies, Female, Humans, Male, Middle Aged, Walking, Weight-Bearing, Foot Ulcer

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