Academic journal article Journal of Cultural Diversity

Weight-Bearing Activity and Foot Parameters in Native Americans with Diabetes with and without Foot Sensation

Academic journal article Journal of Cultural Diversity

Weight-Bearing Activity and Foot Parameters in Native Americans with Diabetes with and without Foot Sensation

Article excerpt

Abstract: Amputations from diabetic foot ulcers account for substantial health care costs and pain. At the point of neuropathy, it has been recommended that weight-bearing activities (WBA) be restricted to reduce the risk of ulcers. While regular WBA has been shown to control glycemia, stress from this exercise may lead to ulcers by various processes. This investigation compared Native Americans with diabetes, with or without foot sensation ana who reported regular or no leisure-time WBA, with variables of significance for risk of diabetic foot ulcers. Analysis revealed that there were no differences in barefoot standing plantar pressure or plantar skin hardness between the four groups. Further study is recommended with a larger sample and the use of instruments that are more valid and reliable.

Key Words: Weight-bearing Activity, Native Americans, Diabetes, Plantar Foot Ulcers

INTRODUCTION

Neuropathy-related abnormalities of autonomic, motor and sensory pathways of the lower limb provide the greatest risk for diabetic foot ulcer(s) (DFU) and, ultimately, limb amputations. Neuropathy contributes to foot ulceration through numerous mechanisms that result in changes of the foot, including loss of protective sensation, altered foot structure and autonomic dysidrosis (a chronic dermatosis). Distal symmetric sensorimotor polyneuropathy is one of most prevalent, costly and debilitating disease conditions affecting individuals with long-standing and uncontrolled hyperglycemia. Currently, the only treatment for the prevention of neuropathy is to control glycemia and the performance of routine exercise is one way to achieve this. It is recommended by the American Diabetes Association that people with diabetes (PWD) should exercise, in their leisure time, at moderate-intensity, dynamic-type activity, at least three days per week for 150 minutes per week in order to maintain euglycemia (ADA, 2006). With euglycemia, the progression of diabetic neuropathy may be delayed or prevented and the risk of DFU development decreased. It is strongly suggested that non-weight bearing exercise be the norm for routine activity when severe peripheral neuropathy is detected because weight-bearing activity (WBA) may lead to skin breakdown, infection, and Charcot joint (ADA, 2006). Studies have shown that PWD prefer walking for their program of exercise (Lemaster, Reiber, Smith, Heagerty, & Wallace, 2003) but mechanical forces that contribute to foot ulceration are thought to occur from those associated with daily WBA, such as walking. Recent research has primarily focused on the investigation of levels of weight-bearing activity and the incidence of subsequent ulcer formation. Results of these investigations reveal that 1) WBA does not necessarily increase the risk for DFU in those with insensate feet (Lemaster et al., 2003), 2) PWD and a history of DFU may be prone to further injury at relatively lower levels of WBA (Armstrong et al., 2004; Maluf & Mueller, 2003) and, 3) tissue damage may primarily occur from specific patterns of WBA (Armstrong et al., 2004; Loft, Maluf, Sinacore, & Mueller, 2005). Higher-than-normal foot sole skin hardness (SH) and plantar pressures (PP) have been implicated as risk factors for developing DFU, and both of these may be useful in monitoring the plantar foot that is subjected to routine WBA. Moreover, Native Americans (NA) experience more diabetes disproportionately than other racial/ethnic minority groups in the Uniteci States with prevalence of the disease being three times higher than non-native adults (CDC, 2003a). Age-specific lower extremity amputation rates from DFU have been found to be 3.5 times higher in NA than in Caucasians (CDC, 2003b). Therefore, prevention of DFU, including the initial one, is of the utmost importance. Unknown is the link between WBA and plantar foot parameters in NA with diabetes mellitus (DM), with and without sensate feet and who have never developed DFU. …

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