Effect of selected exercises on in-shoe plantar pressures in people with diabetes and peripheral neuropathy

Abstract

Background: In people with diabetes and peripheral neuropathy (DM+PN), injury risk is not clearly known for weight bearing (WB) vs. non-weight bearing (NWB) exercise. In-shoe peak plantar pressures (PPP) often are used as a surrogate indicator of injury to the insensitive foot.

Objective: Compare PPPs in people with DM+PN during selected WB and NWB exercises.

Methods: Fifteen subjects with DM+PN participated. PPPs were recorded for the forefoot, midfoot, and heel during level walking and compared to; WB exercises--treadmill walking, heel and toe raises, sit to stands, stair climbing, single leg standing; and NWB exercises--stationary bicycling, balance ball exercise and plantar flexion exercise.

Results: Compared to level walking; mean forefoot PPP during treadmill walking was 13% higher, but this difference was eliminated when walking speed was used as a covariate. Mean PPPs were similar or substantially lower for other exercises, except for higher forefoot PPP with heel raise exercises.

Conclusions: Slow progression and regular monitoring of insensitive feet are recommended for all exercises, but especially for heel raises, and increases in walking speed. The remaining WB and NWB exercises pose no greater risk to the insensitive foot due to increases in PPP compared to level walking.

Figure 1. Plantar pressures compared to level walking

Data represented as percentages. PPP=Peak plantar pressure; TM=treadmill walking; HR=heel raise; TR=toe raise; SL=single leg standing; SC=stair climbing; SS=sit to stand; RB=recumbent biking; UB=upright biking; PF=plantar flexion exercise; BE=balance ball exercise.