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Effect of Weight-Bearing Activity on Foot Ulcer Incidence in People With Diabetic Peripheral Neuropathy: Feet First Randomized Controlled Trial
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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“However, recent studies indicated that moderate walking does not increase risk of foot ulcers or reulceration in those with peripheral neuropathy ( 166 , 167 ).”
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“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 ).”
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Metadata
- 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
- 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
- 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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