Supportive Treatment for Diabetic Peripheral Neuropathy



Supportive Treatment for Diabetic Peripheral Neuropathy

Neuropathic conditions are complex and often possess a multifactorial aetiology that leads to disruption in the functioning of three types of nerves – autonomic, motor and sensory.

Among the different types of neuropathy that can affect an individual, peripheral neuropathy is perhaps the most extensively researched because of its effect on the mobility of an individual; diabetic peripheral neuropathy is considered as accounting for significant morbidity and mortality rates worldwide.

The biomechanical characteristics of diabetic peripheral neuropathy, especially its influence on the gait cycle, muscle activation and dynamic barefoot plantar pressure, were investigated in further detail by Fernando et al. by conducting a review of sixteen studies on the subject.

Based on the findings of the studies, the authors concluded that the biomechanical factors that seemed significantly different in patients with diabetic peripheral neuropathy were – elevated plantar pressure and longer stance time during gait.

This implies that elevated plantar pressure levels, together with a longer period of time spent in stance, increase susceptibility to skin damage and ulceration in patients through prolonged mechanical load on tissue.

Ferreira et al. sought to study the effect of peripheral neuropathy on lower limb muscle strength by evaluating peak torques in the concentric, eccentric and isometric contractions of three groups of adult men during knee and ankle flexion and extension.

Of these men, 33 were non-diabetic controls, 31 had type 2 diabetes mellitus and 28 had diabetic peripheral neuropathy.

Using an isokinetic dynamometer, the authors determined that decrease in concentric and isometric peak torques occurred in patients with type 2 diabetes mellitus even before the onset of diabetic peripheral neuropathy for all the knee motions and almost all of the ankle motions.

Eccentric torque was observed to be preserved in all of the joint movements in both patients with type 2 diabetes mellitus and patients with diabetic peripheral neuropathy.

These two findings can have important implications in the development of preventative and treatment strategies for the diabetic population especially in terms of formulating successful early identification tools that could help promote improved stability and mobility in individuals with type 2 diabetes mellitus.

Highly customised orthotics can play an essential role in reducing high peak pressures on the plantar aspect of the neuropathic foot by evenly distributing forces from weightbearing and physical activities to decrease localised stress and the risk of ulceration.

Donovan J. Lott, of the Movement Science Programme at the Washington University, recorded tissue strain and plantar pressure data at the second metatarsal head for twenty subjects with diabetes mellitus, peripheral neuropathy and a history of plantar ulceration under four conditions – barefoot, shoe, shoe with total contact insert and shoe with total contact insert and metatarsal pad.

The results demonstrated a reduction in pressure and soft tissue strain at the second metatarsal head with the inclusion of footwear and orthotic devices during the simulated terminal stance of gait.

Custom foot orthotics help to improve ambulation by reducing hyperpronation and the stress on the muscles of the foot and leg. This allows the patient to remain active with walking and exercises, lessening the possibility of other diabetic complications such as heart diseases, kidney disease or a stroke.

While maximising the remaining functional integrity of the foot, MASS4D® customised foot orthotics also offer a special Bi-Lam cushion top cover for patients suffering from insensate foot symptoms; this provides protection against unnoticed blistering or ulcerations for this population, in addition to helping improve functionality in the lower limbs.

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References:

  1. Ferreira, J. P., Sartor, C. D., Leal, A. M. O., Sacco, I. C. N., Sato, T. O., Ribeiro, I. L., Soares, A. S., Cunha, J. E., Salvini, T. F. (2017) The Effect of Peripheral Neuropathy on Lower Limb Muscle Strength in Diabetic Individuals. Clinical Biomechanics: February 2017, Vol. 43, pp. 67-73. DOI: 10.1016/j.clinbiomech.2017.02.003
  2. Fernando, M., Crowther, R., Lazzarini, P., Sangla, K., Cunningham, M., Buttner, P., Golledge, J. (2013) Biomechanical Characteristics of Peripheral Diabetic Neuropathy: A Systematic Review And Meta-Analysis of Findings From The Gait Cycle, Muscle Activity And Dynamic Barefoot Plantar Pressure. Clinical Biomechanics: August 2013, Vol. 28, pp. 831-845. DOI: 10.1016/j.clinbiomech.2013.08.004
  3. Lott, D. J., Hastings, M. K., Commean, P. K., Smith, K. E., Mueller, M. J. (2007)  Effect of Footwear and Orthotic Devices on Stress Reduction and Soft Tissue Strain of the Neuropathic Foot. Clinical Biomechanics (Bristol, Avon): March 2007, Vol. 22, No. 3, pp. 352-359. DOI: 10.1016/j.clinbiomech.2006.10.010

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