SLR - August 2015 - Zara Hercules

Effects of Thai Foot Massage on Balance Performance in Diabetic Patients with Peripheral Neuropathy:  A Randomized Parallel-Controlled Trial

Reference: Chatchawan U, Eungpinichpong W, Plandee P, Yamauchi J. Effects of Thai Foot Massage on Balance Performance in Diabetic Patients with Peripheral Neuropathy: A Randomized Parallel-controlled Trial. Med Sci Monit Basic Res. 2015 Apr 20; 21:68-75

Scientific Literature Review

Reviewed By: Zara Hercules, DPM
Residency Program: Wyckoff Heights Medical Center

Podiatric Relevance: This is an interesting article because it is a holistic approach to managing peripheral neuropathy. Thai foot massage can easily be incorporated into the care and treatment plan of the diabetic neuropathic patient. Whether the option of surgical intervention is crucial or a practicable cosmetic procedure, this type of non-invasive therapy can be beneficial to either process. The diabetic neuropathic patient can gain self-confidence and balance through Thai foot massage soon after an initial treatment.  

In some cases of patient with peripheral neuropathy, something as subtle as losing feeling and balance in the feet can be the starting point of self-doubt. Diabetes can take so much away from a person and the diabetic patient can frequently, quietly and privately suffer emotionally. Patients that feel more in control of their physical health are the patients that are more likely to comply with post-op instructions and with long-term recommendations. Helping our diabetic patients maintain a decent quality of life is what we ultimately strive to do.  The clinical question the authors were attempting to answer here was whether or not Thai foot massage is a viable complementary treatment for balance performance, ROM of the foot, and sensation in diabetic patients with peripheral neuropathy. All of these areas are of significance to the podiatric surgeon. Holistically, Thai foot massage is not complex and it is easy to perform. This technique may be a viable treatment for home health care to provide as well as in the clinical setting for the diabetic neuropathic patient.  

Methods: Sixty patients with type II diabetes were randomly assigned to either the Thai foot massage or control groups. The control group received health education guidelines for self-care that included washing and checking feet daily, applying lotion to the feet, avoid wearing tight shoes, wearing shoes and socks at all times and refraining from smoking.  

The Thai foot massage group received a modified Thai traditional foot massage for 30 minutes three days per week for two weeks. Remaining below the pressure pain threshold, direct thumb pressure was applied until the participant started to feel some discomfort. The pressure is maintained for 5-10 seconds at each Thai meridian pressure point. First, pressure was directed plantarly from the heel to the base of the metatarsophalangeal joints. Second, onto the dorsum of the foot from the ankle to the base of the metatarsophalangeal joint.  Third, attention is directed to the lower anterior leg inferior to superior along the tibialis anterior. Followed by attention to the lower posterior leg inferior to superior along the gastrocnemius muscles and then around the knee. This technique is done in supine and lateral decubitus positions. They measured time up and go (TUG), one leg stance (OLS), the range of motion (ROM) of the foot, and foot sensation via Semmes-Weinstein Monofilament Test (SWMT) before treatment, after the first single massage session and after two weeks of treatment.

Results: Immediately after the foot massage, timed getting up and going (TUG) was recorded in minutes. In the single treatment session, only the Thai foot massage group showed a significant improvement in TUG. After the two weeks treatment, both the Thai foot massage and the control group showed a significant improvement in TUG and OLS. However, when comparing between the two groups, the Thai foot massage group showed better improvement in TUG than the control group. The Thai foot massage group also showed significant improvements in ROM and SWMT base line level of sensation between having neuropathy and having normal sensation after the two week treatment.

Conclusion: Direct-deep pressure combined with gentle distraction on the muscle and joints of the foot and lower leg as done with Thai foot massage can increase local blood circulation with stimulation of their somatosensory system. So, when sensory and segmental adjustments play a positive intricate role in postural control by changing pressure distribution, proprioception, muscle tension, joint angle and muscle length, this can have a profound and positive effect on my type II diabetic patient that has peripherally neuropathy in a noteworthy and measureable way.

Thai foot massage can be a viable complementary treatment for balance performance, ROM of the foot and for foot sensation in diabetic patients with peripheral neuropathy. When considering surgical intervention on the type II diabetic patient with peripheral neuropathy, this information can help the podiatric surgeon treat the patient holistically as well. Thai foot massage can be a viable treatment when used in conjunction with the patient’s current medical program.

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