Guest Columnist: Janet Caputo, PT, DPT, OCS
New research has found that exercise may help in the prevention of foot ulcers. Foot ulcers, while originally appearing as small and benign, often lead to one of the most serious problems in people with diabetes, amputation. Prevention is essential and understanding the risk factors and causes of foot ulcers is the first step. The most common risk factors for foot ulcers in diabetics are; foot deformities, loss of sensation, poor circulation, dry skin, and calluses. Once an ulcer forms, a diabetic’s weak immune system cannot fight the infection. Even worse, the antibiotics used to fight the infection cannot reach the infected area, because of poor circulation associated with diabetes. Over time, gangrene (death of tissue) may occur which may lead to amputation. Therefore, people with diabetes are encouraged to take care of their feet to prevent these ulcers. New research has found that weight bearing exercise, such as walking, can prevent foot ulcers. Also, regular visits to a podiatrist, proper shoe wear, controlling cholesterol and blood sugar and avoiding tobacco products help to prevent foot ulcers.
The tried and proven methods of preventing foot ulcers are; controlling blood sugar, lowering cholesterol and quitting smoking. While these options are difficult, the addition of weight bearing exercise, like walking, can control cholesterol and blood sugar AND PREVENT foot ulcers!
Dr. John O’Malley, Ph.D., professor at the University of Scranton, uses walking to control his diabetes. His biggest fear is not being able to walk, because he feels that WALKING is his LIFELINE! Dr. O’Malley has had diabetes for 14 years, but walks up to 8 miles every day. At one point, he did have a foot ulcer, but he said that he developed the ulcer during his “less active” years. Finally, current wisdom is catching up with what he knew all along…walking is the answer!
Some medical professionals caution people with diabetes about weight bearing exercise (i.e. walking, dancing, hiking, low impact aerobics, golfing, yoga, and Tai Chi) because of increased pressure on their feet, which was believed to lead to ulceration, especially in those with loss of sensation. Recent medical research, however, shows that weight bearing exercise does not increase the risk for foot ulcers, and that those people who were the most active actually reduced their risk for ulceration.
The American Diabetes Association promotes weight bearing exercise for people who do not currently have foot ulcers because people who performed weight bearing exercise developed less foot ulcers, and because this type of exercise could prevent, or at least delay, the development of diabetic neuropathy (i.e. loss of sensation).
How could an exercise that increases foot pressure prevent foot ulcers? “If you don’t use it, you lose it.” Our body’s tissues (i.e. skin, muscle, tendon, ligament, bone) respond to pressure, stress, force, load, or whatever you want to call it. A tissue that does not get used will get weak and shrink. A tissue that gets overused will get injured. But the tissue that gets a moderate to high level of stress becomes stronger.
It is foolish to rush out and walk ten miles after sitting in your rocking chair or on your couch for twelve hours a day for the past ten years. First, ask your foot doctor if you can begin a weight bearing exercise program. If you have a foot ulcer, they will not advise you to do so. Also, your doctor may suggest that you should be fitted for special shoes and inserts before you begin your program to properly support your delicate foot. Second, make sure your blood sugar is under control. High blood sugar reduces healing in your tissues. When you exercise, tissues are strained and need to recover. Third, start slow and increase your exercise gra-du-al-ly. If you are a couch potato, you may need to start by walking only a half a block and increase your distance by ¼ block intervals every couple of days. Your podiatrist might recommend a visit to a physical therapist to advise how to properly begin and advance your exercise routine. Your physical therapist can also help to identify certain problem areas that might make you more prone to foot ulcers (i.e. loss of joint flexibility, muscle weakness, improper walking style, balance problems) and make suggestions to remedy these potential problems. Fourth, monitor your feet! Use a mirror to look at the bottoms of your feet. Your feet need to be checked just like you need to check your blood sugar. Check your feet regularly and, at least, before and after your exercise routine. If you notice any change in either foot, stop your exercise and call your foot doctor. Following these four steps and engaging in regular exercise will not only help you prevent foot ulcers but also keep your heart and bones strong!
Source: Lower Extremity Review
CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.
Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune. Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an Associate Clinical Professor of Medicine at The Commonwealth Medical College.
