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Diabetic Foot Problems

People with diabetes cannot feel when they are stepping on a foreign body, like a splinter, or when they are developing a callous from an ill-fitting shoe. Consequently, they are at risk of developing ulcers and infections on the feet and legs, which can lead to amputation.

Who it affects: 
Diabetic foot ulceration occurs in 15% of all patients with diabetes and precedes 84% of all diabetes-related lower leg amputations.
Symptoms: 

Deep pain in the feet and legs, tingling or burning sensation in extremities, muscle cramps, muscle weakness, sexual dysfunction, and diabetic foot.

Diabetic foot can result in many problems, including:
  • Loss of motor function
  • Difficulty moving the foot upwards at the ankle joint
  • Permanent shortening of the joints or muscles of the toes
  • Loss of the interosseous muscle function
  • Contraction of the digits, called hammer toes
Treatment: 

Physical therapy can be an effective and alternative treatment option for patients with diabetes. This may help reduce dependency on pain relieving drug therapies.

Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) use a painless electric current and the physiological effects from low frequency electrical stimulation to relieve stiffness, improve mobility, relieve neuropathic pain, reduce oedema, and heal resistant foot ulcers.

Gait training, posture training, and teaching these patients the basic principles of off-loading can help prevent and/or stabilize foot complications such as foot ulcers. Off-loading techniques can include the use of mobility aids (e.g. crutches) or foot splints. Gait re-training would also be beneficial for individuals who have lost limbs, due to diabetic neuropathy, and now wear a prosthesis.

Exercise programs, along with manual therapy, will help to prevent muscle contractures, spasms and atrophy. These programs may include general muscle stretching to maintain muscle length and a person’s range of motion. General muscle strengthening exercises will help to maintain muscle strength and reduce muscle wasting. Aerobic exercise such as swimming and using a stationary bicycle can help peripheral neuropathy, but activities that place excessive pressure on the feet (e.g. walking long distances, running) may be contraindicated.