A quantitative real-time assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot

The Effect of Modified Buerger-Allen Exercises on Lower Extremities Edema in Late Pregnancy: Randomized Clinical Trial

Background

Lower limbs edema is one of the common problems in late pregnancy. This study aimed to determine the effect of modified Berger-Allen exercises on lower limb swelling in late pregnancy.

Materials and Methods

This randomized clinical trial was conducted on 105 pregnant women suffering from lower limbs edema. Samples were randomly placed in three groups: modified Buerger-Allen exercises for five days, modified Buerger-Allen exercises for ten days, and the control group. Foot circumferences and volume and pain were measured before and after the study.

Results

There was a significant difference between the average of right and left ankle circumference, right and left heel circumference, right and left foot circumference, left foot volume and pain score after the 5-day intervention group (p < 0.05). In the 10-day intervention group, there was a significant difference in all averages of ankles, heels, foot circumference and volume, and pain score 10 days after the intervention, compared to before the intervention (p < 0.05).

Conclusion

Performing innovative modified Buerger-Allen exercises in pregnant women with lower limbs edema may reduce their pain and swelling. It can also reduce the leg areas in pregnant women with lower limb edema in late pregnancy.

Trial registration

Approval number from Iranian Registry of Clinical Trials: IRCT20200713048096N1 (Registration date: 2020-11-12).

Local microvascular tissue oxygenation of the intrinsic foot muscles in patients with diabetes: A cross-sectional case-comparison study

BACKGROUND

Foot-related complications including impaired peripheral circulation and lower limb ulceration are severe consequences for those with diabetes mellitus. This study aimed to assess differences in tissue oxygenation and oxygen utilization of the plantar surface intrinsic foot muscles between diabetic participants and healthy comparisons following short foot exercise and a standard walking protocol.

METHODS

Eighteen participants, 9 with diabetes and 9 healthy age- and sex-matched comparisons, completed two interventions in a randomized order. For the short foot exercise intervention, participants completed 5 sets of 15 intrinsic foot muscle contractions. For the walking intervention, participants completed a modified six-minute walk test. Tissue oxygenation variables including oxygenated hemoglobin, deoxygenated hemoglobin, and tissue saturation index were measured using near-infrared spectroscopy in quiet stance and during intrinsic foot muscle contraction cycles following each intervention. Means, standard deviations, 95 % confidence intervals, mean differences, and Cohen's d effect sizes were calculated for each tissue oxygenation variable.

RESULTS

The results of this study indicated no significant group differences in quiet standing tissue oxygenation measures at baseline and following each intervention. Participants in the diabetic group had significantly less change in tissue saturation index during intrinsic foot muscle contractions compared to healthy participants after the short foot exercise intervention (ES= 4.00, P = .0002) and walking intervention (ES= 1.33, P = .015).

CONCLUSIONS

By utilizing wireless NIRS and novel research methodology, this study was able to explore changes in plantar surface tissue oxygenation of the intrinsic foot muscles following a targeted short foot exercise intervention as well as a standard walking protocol in patients diagnosed with diabetes compared to age- and sex- matched individuals without diabetes. We identified that diabetic participants presented with less oxygen utilization during intrinsic foot muscle contractions performed following both exercise interventions compared to their healthy age- and sex- matched comparisons.

Effect of buerger allen exercise on foot perfusion among patient with diabetes mellitus: A systematic review & meta-analysis

AIM

Buerger-Allen exercise includes set of activities like elevation, movement and rest of the lower extremities. This systematic review and meta-analysis aimed to assess the effectiveness of BAE on foot perfusion among patient with diabetes mellitus.

MATERIAL & METHODS

Five databases were searched for literatures published from inception to October 2020. Cochrane Collaboration Tool for RCTs and ROBINS-I tool for quasi-experimental studies were used for quality assessment.

RESULTS

Four RCTs and six quasi-experimental studies were included, and pooled analysis have shown that the BAE was significantly effective in the improvement of ABI scores (MD = 0.14; 95% CI 0.08-0.19; I² = 30%; p < 0.000).

CONCLUSIONS

Studies showed that BAE effectively improves foot perfusion among patients with diabetes mellitus.

Spinal cord stimulation for the treatment of pain and toe ulceration associated with systemic sclerosis: a case report

Systemic sclerosis is a complex disease characterized by extensive fibrosis, microvascular alterations, and additional sequelae. Microvascular alterations can cause painful ulcers and necrosis; however, conservative or surgical treatment is often challenging in terms of healing. The study aimed to describe a toe ulcer with systemic sclerosis and its’ successful treatment with spinal cord stimulation. An 83-year-old woman, who was diagnosed with systemic sclerosis over the past decade, was distressed by a non-healing toe ulcer for an extended period of time. The patient underwent spinal cord stimulation treatment with the expectation of pain relief and an improvement in microcirculatory insufficiency. Her pain scales and microcirculation improved, and the toe ulcer healed. Furthermore, the frequency of Raynaud’s symptoms was reduced, and the patient’s pain decreased. There was no recurrence of the ulcer and she no longer needed a cane for walking.

Buerger Exercise Reduces the Risk of Neuropathy in People with Diabetes Mellitus

Introduction: Diabetes mellitus (DM) remains the major global health problem, predicted to exceed half a billion people in 2040. One of the major complications was lower extremity neuropathy leading to foot ulcer and amputation. This study aimed to investigate the effect of routine Buerger exercise on the neuropathy index of people with DM. Methods: A pre-and posttest quasi-experimental study between May and August 2018 involving DM patients in primary health centre was conducted. They were prospectively recruited and either be allocated into the intervention group where the monitored routine Buerger exercise was performed or control group with the standard education on DM. Michigan Neuropathy Screening Instrument (MNSI) with subjective and objective measurement was used to evaluate the neuropathy index. Results: Seventy-seven participants (63 females) with mean age of 58.2±7.2 years completed the study with similar characteristics. Mean pretest MNSI score for intervention and control group were 3.8±1.7 and 3.9±1.6 respectively, and were not different (P = 0.561). At the end of follow up, significant decrease was observed in the intervention group (2.8±2.2, P = 0.011) but not in control group (4.0±1.9, P=0.947). Physical examination according to MNSI guideline showed a significant reduction in the neuropathy score for the intervention group from 1.8±1.4 at the start to 1.3±1.1 at the end of the study (P< 0.001), but this was not seen in the control group. Conclusion: Buerger exercise had a beneficial effect on improving the neuropathy index and symptoms of DM patients with high risk of diabetic foot ulcer.

Benefits and Harms of Exercise Therapy for Patients With Diabetic Foot Ulcers: A Systematic Review

AIM

Exercise therapy is a core element in the treatment of diabetes, but the benefits and harms for patients with a diabetic foot ulcer (DFU) are unknown. We therefore aimed to systematically review the benefits on health-related quality of life (HRQoL) and harms of exercise therapy for patients with DFU.

METHODS

We searched 6 major databases. We performed citation and reference searches of included studies and contacted authors of ongoing trials. We included randomized controlled trials (RCTs) to assess potential benefits on HRQoL and harms of exercise therapy. Observational studies were included to identify potential harms of exercise therapy.

RESULTS

We included 10 published publications of 9 trials and results from 2 unpublished trials including a total of 281 individuals with DFUs receiving various forms of exercise therapy. Due to lack of HRQoL measurements and high heterogeneity, it was not possible to perform meta-analyses. Results on HRQoL was present in one unpublished study. Harms reported ranged from musculoskeletal problems, increased wound size, to amputation; however, no safe conclusions could be drawn from the available data due to high heterogeneity and risk of bias in the trials.

CONCLUSIONS/INTERPRETATION

Protective strategies are often preferred over therapeutic exercise that might have unforeseen consequences for patients over time. Based on the current literature, no evidence-based recommendations can be provided on the benefits and harms of exercise therapy for patients with DFUs. Well-conducted RCTs are needed to guide rehabilitation including detailed description of adverse events and an exercise program in a semisupervised or fully supervised setting.

Foot care knowledge, attitudes and practices among patients with diabetic foot and amputation in St. Kitts and Nevis

About one-third of admissions to the surgical unit annually are diabetes foot infections in need of amputation In St. Kitts and Nevis. However, the risk factors related to diabetes foot and amputation remain unknown. This study investigated factors associated with diabetic foot and amputation (DFA). Retrospective case control study design, and purposive and quota sampling method was used to recruit the participants. Patients with and without DFA were interviewed at two main hospitals, several primary health centres, and a private doctor's office during July and August 2018. Self-development questionnaires were applied to assess patients' demographic, physical and behaviour, foot care knowledge, attitudes, and practices related to DFA. Chi-square, t-test, and multiple logistic regressions were used to analyse the data. A total of 210 patients were evaluated, 89 had DFA, while 121 did not, with a mean age of 61.10 (SD = 11.85). Participants' responses indicated good knowledge, favourable attitudes, and adequate practices related to foot care. The two items of the questionnaire, ways to maintain blood flow in the lower extremities and wash their feet daily, had significant lower score in DFA group. In multiple logistic regression, knowledge, attitudes, and practices related to foot care were not a significant predictor of DFA. Being male was a predictor of DFA than female (OR = 3.53; 95% CI = 1.65-7.57; P < .01). Participants who were currently unemployed were less likely to have DFA than those who were employed (OR = 0.38; 95% Cl = 0.17-0.86; P < .05). Comparing patients with the longest experience of diabetes mellitus (31 years or more) with those who had diabetes for the shortest period of time (between 1 and 10 years) was less likely to have DFA (OR = 0.38; 95% CI = 0.15-0.97; P = <.05). The combination of these independent variables could explain 29% of the variance in DFA. Based on these findings, strategies to prevent diabetic foot and amputation should focus on male and outdoor heavy worker, and longer duration of diabetes patients which are identified in this study.