Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?

Table 1 Causes and effects of the factors that lead to the diabetic foot infection pathogenesis[10]

Risk factor	Cause/effect of the risk factor
Peripheral motor neuropathy	Abnormal foot anatomy and bio-mechanics, manifesting with paw feet, high foot arch, subluxed metatarsophalangeal joints, increased foot pressure and callus formation
Peripheral sensory neuropathy	Minor chronic injuries secondary to heat, mechanical or high pressure as a result of deficiency of protective pain sensation
Peripheral autonomic neuropathy	Cracks on the dry skin due to reduced moisture
Neuroosteoarthropodic deformities	Abnormal foot anatomy and bio-mechanics secondary to increased foot pressure (particularly in the midplantar region)
Vascular failure	Reduced neutrophil migration, loss of the tissue viability and delayed wound healing
Uncontrolled blood sugar and other metabolic imbalances	Deficient immune system (particularly in the neutrophil functions), wound healing and collagen production
Patient characteristics	Loss of vision, limited motion, previous amputation(s)
Incompliant patient attitude	incompliance with the hygiene rules, foot care, prophylactic measures and healthcare principles (excessive weight gain, etc.)
Inadequacy of the healthcare system	Inadequate patient training on foot care, blood sugar control etc.; insufficient treatment centers that provide one-to-one patient care and/or insufficient bed counts; deficiency of a multi-disciplinary approach

Table 2 Physical therapy modalities potentially beneficial for wound healing

Heating agents	Electrotherapy methods
Superficial heaters: Infrared treatment, global heat treatment	Electrical stimulation
Deep heaters: Ultrasound treatment	Shock wave therapy (ESWT)
	Laser treatment
	Magnetic field treatment
	Galvanic current treatment

ESWT: Extracorporeal shock wave therapy.

Table 3 Laser types used in the clinical practice and their contents

Low-level lasers (cold laser)	Helium and neon
Moderate-level lasers	Gallium, aluminum-arsenide
Potent lasers	Argon-CO-Yttrium aluminum oxide