Physiotherapeutic Interventions in Diabetic Foot Ulcer Management: A Case Report

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Apr 1

PMID 38558580

Authors

Vaishnavi R Waghe

Vrushali Athawale

Affiliations

Soon will be listed here.

Abstract

Diabetic foot ulcers (DFUs) represent prominent complications arising from diabetes mellitus, characterized by the development of severe and persistent wounds involving the loss of epidermal and/or dermal layers, with the potential to extend into subcutaneous and underlying tissue structures. In the presented case, a 62-year-old male patient presented with complaints of pain and the emergence of blisters on the right foot, marked by an insidious onset and gradual progression in size, ultimately leading to ulcer formation subsequent to blister rupture. The patient had a medical history spanning 25 years of diabetes mellitus, accompanied by diminished range of motion and muscle strength in the affected foot. The primary goals in the management of DFU encompass addressing muscular weakness, skin manifestations, and any associated underlying health comorbidities. Central to this management approach lies the incorporation of physical therapy and rehabilitation modalities. The rehabilitation regimen designed for the patient was tailored to include targeted resistance exercises, infrared radiation therapy, and sensory integration therapy. Outcome measures, including the Numeric Pain Rating Scale (NPRS), World Health Organization Quality of Life questionnaire (WHO-QOL), and Diabetic Foot Self-Care Questionnaire (DFSQ-UMA), demonstrated substantial improvements, reflecting enhanced activities of daily living. This case underscores the pivotal role of incorporating physiotherapy into a comprehensive multidisciplinary approach for optimizing the management of DFUs. Such integration aims to improve patient outcomes and overall quality of life.

References

Liao F, An R, Pu F, Burns S, Shen S, Jan Y . Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil. 2018; 98(2):103-116. DOI: 10.1097/PHM.0000000000001002. View

Lindberg K, Moller B, Kirketerp-Moller K, Kristensen M . An exercise program for people with severe peripheral neuropathy and diabetic foot ulcers - a case series on feasibility and safety. Disabil Rehabil. 2018; 42(2):183-189. DOI: 10.1080/09638288.2018.1494212. View

Bandyk D . The diabetic foot: Pathophysiology, evaluation, and treatment. Semin Vasc Surg. 2019; 31(2-4):43-48. DOI: 10.1053/j.semvascsurg.2019.02.001. View

Boyd A, Casselini C, Vinik E, Vinik A . Quality of life and objective measures of diabetic neuropathy in a prospective placebo-controlled trial of ruboxistaurin and topiramate. J Diabetes Sci Technol. 2011; 5(3):714-22. PMC: 3192638. DOI: 10.1177/193229681100500326. View

Thomas D, Elliott E, Naughton G . Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006; (3):CD002968. PMC: 8989410. DOI: 10.1002/14651858.CD002968.pub2. View

Shankar E, Mohan V, Premalatha G, Srinivasan R, Usha A . Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med. 2005; 16(8):567-70. DOI: 10.1016/j.ejim.2005.06.016. View

Aydin E, Ertugrul M . The role of rehabilitation in the management of diabetic foot wounds. Turk J Phys Med Rehabil. 2022; 67(4):389-398. PMC: 8790253. DOI: 10.5606/tftrd.2021.8616. View

Medeiros S, Rodrigues A, Costa R . Physiotherapeutic interventions in the treatment of patients with diabetic foot ulcers: a systematic literature review. Physiotherapy. 2022; 118:79-87. DOI: 10.1016/j.physio.2022.09.006. View

Armstrong D, Cohen K, Courric S, Bharara M, Marston W . Diabetic foot ulcers and vascular insufficiency: our population has changed, but our methods have not. J Diabetes Sci Technol. 2012; 5(6):1591-5. PMC: 3262731. DOI: 10.1177/193229681100500636. View

10.

Olver T, Laughlin M . Endurance, interval sprint, and resistance exercise training: impact on microvascular dysfunction in type 2 diabetes. Am J Physiol Heart Circ Physiol. 2015; 310(3):H337-50. PMC: 4796622. DOI: 10.1152/ajpheart.00440.2015. View

11.

Belatti D, Phisitkul P . Declines in lower extremity amputation in the US Medicare population, 2000-2010. Foot Ankle Int. 2013; 34(7):923-31. DOI: 10.1177/1071100713475357. View

12.

. Diabetic neuropathy. Nat Rev Dis Primers. 2019; 5(1):42. PMC: 7096070. DOI: 10.1038/s41572-019-0097-9. View

13.

Asadi M, Torkaman G, Hedayati M, Mohajeri-Tehrani M, Ahmadi M, Gohardani R . Angiogenic effects of low-intensity cathodal direct current on ischemic diabetic foot ulcers: A randomized controlled trial. Diabetes Res Clin Pract. 2017; 127:147-155. DOI: 10.1016/j.diabres.2017.03.012. View

14.

Huang Q, Yan P, Xiong H, Shuai T, Liu J, Zhu L . Extracorporeal Shock Wave Therapy for Treating Foot Ulcers in Adults With Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Can J Diabetes. 2019; 44(2):196-204.e3. DOI: 10.1016/j.jcjd.2019.05.006. View

15.

Laughlin M . Physical activity-induced remodeling of vasculature in skeletal muscle: role in treatment of type 2 diabetes. J Appl Physiol (1985). 2015; 120(1):1-16. PMC: 4698444. DOI: 10.1152/japplphysiol.00789.2015. View

16.

Francia P, De Bellis A, Seghieri G, Tedeschi A, Iannone G, Anichini R . Continuous Movement Monitoring of Daily Living Activities for Prevention of Diabetic Foot Ulcer: A Review of Literature. Int J Prev Med. 2019; 10:22. PMC: 6390424. DOI: 10.4103/ijpvm.IJPVM_410_17. View

17.

McDermott K, Fang M, Boulton A, Selvin E, Hicks C . Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2022; 46(1):209-221. PMC: 9797649. DOI: 10.2337/dci22-0043. View