April 2019

Plantar Mechanical Stimulation Improves Sensation in DPN

Figure 1: The wearable foot compression device installed in a shoe insole

By Bijan Najafi and Gu Eon Kang

Over 30 million Americans have diabetes and 1.5 million Americans are newly diagnosed with diabetes each year. Peripheral neuropathy (PN) is a major diabetic complication and affects 30% to 50% of people with diabetes. Diabetic peripheral neuropathy (DPN) is a leading cause of devastating outcomes such as foot ulcer and amputation. DPN also causes diminished sensation in the foot, and, consequently, people with DPN have impairment in motor functions such as gait and balance, which increases risk of injury during daily movements such as falling and mortality rate. In order to tackle this problem, researchers have been trying numerous non-surgical and non-pharmacological trials.

In a recent study, researchers from the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) at the Baylor College of Medicine, evaluated therapeutic effectiveness of plantar mechanical stimulation on neuropathy symptoms using wearable foot compression devices installed in shoe insoles (FootBeat™, AVEX, CO, USA, Figure 1). The study participants—30 people with DPN—wore the shoes equipped with the wearable foot compression devices during daily activities for 4 weeks. Changes in plantar sensation as well as gait and balance performance were assessed at 4 weeks compared to baseline. The findings were published in the Journal of Diabetes Science and Technology.

The study found that plantar sensation was significantly improved, on average by 15% (p=.007) after the intervention. The data also show that the intervention led to improvement in several gait and balance parameters of interest, including increases in gait speed during habitual speed walking (10%, p=.001), fast walking (9%, p=.043), and dual-task walking (walking while performing a cognitively demanding task; 21%, p=.017). For balance performance, body sway in the medio-lateral direction decreased by approximately 19% (p=.020) during eyes-open condition and by 25% (p=.033) during eyes-closed condition.

These findings demonstrated that daily use of plantar mechanical stimulation through a wearable foot compression device installed in shoe insoles is effective for improving plantar sensation, which likely results in improvements in gait and balance performance. The study also evaluated patient perception of benefit, acceptability, and ease of use using a questionnaire based on technology acceptance model and demonstrated that the proposed shoes with plantar compression device are highly acceptable, can be used for daily use without additional discomfort, and are perceived to be beneficial for people with DPN. These findings also highlight the potential of plantar mechanical stimulation as an adjunctive intervention for treating symptoms related to DPN and improving quality of life in people with DPN.

Source: Kang GE, Zahiri M, Lepow B, Saleem N, Najafi B. The effect of daily use of plantar mechanical stimulation through micro-mobile foot compression device installed in shoe insoles on vibration perception, gait and balance in people with diabetic peripheral neuropathy. J Diabetes Sci Tech. 2019 Apr 3:1932296819839703.

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