SLR - February 2018 - Michael J. Price

The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients with a Foot Ulcer

Reference: Eraydin, Sahizer and Gülçin Avsar. "The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients with a Foot Ulcer." Journal of Wound, Ostomy and Continence Nursing, 2017 Dec 19.

Scientific Literature Review

Reviewed By: Michael J. Price, DPM
Residency Program: UF Health Jacksonville, Jacksonville, FL

Podiatric Relevance: Diabetic foot ulcerations (DFUs) are a common condition seen by foot and ankle surgeons. Few studies have examined the effect of exercise on the healing of DFUs. The authors in this study hypothesized that instructing patients to perform nonweightbearing exercise would accelerate healing of DFUs.

Methods: A level II prospective randomized control study was performed for 65 patients with DFUs. Criteria for inclusion comprised of Type II diabetic patients with Wagner Grade I or II DFUs being treated with standard wound care consisting of cleansing the wound followed by dry sterile dressing. Patients receiving advanced wound therapy, such as negative pressure wound therapy or biologic dressings, were excluded, as well as patients with traumatic wounds or DFUs Wagner grade III and above. Patients were randomized into two groups; the intervention group was educated on range-of-motion exercises in addition to receiving standard wound care, while the control group received solely standard wound care. The intervention group was instructed to perform the exercises twice daily for 12 weeks. Wound measurements were taken at baseline and every four weeks during the 12-week treatment course.

Results: Statistically significant reduction in wound area was observed at the end of the 12-week treatment course in both groups. However, while there was a statistically significant reduction in wound area at each follow-up in the treatment group, significant wound area reduction was only observed at the final follow-up in the control group. Additionally, within the study group, patients who exercised for longer periods of time experienced more of a decrease in wound area compared to patients who exercised for shorter periods of time.

Conclusion: The results of this study suggest that exercise may accelerate the healing of DFUs. The authors posited that local hypoxia as a result of exercise leads to compensatory local vasodilation, which may have a beneficial effect on wound healing. Increased tissue oxygenation may also increase angiogenesis, fibroblast proliferation and collagen synthesis—all of which are necessary for wound healing. Based on the results of this study, foot and ankle surgeons who treat DFUs should consider range-of-motion exercise as a possible adjunct in accelerating wound healing.

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