Background: Diabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes mellitus, affecting sensory, motor, and autonomic nerves. It increases the risk of foot ulceration and falls. Management typically involves preventive strategies like patient education, risk stratification, and regular foot screenings. Exercise plays a key role in enhancing glycemic control and nerve function, reducing the risk of DPN and related complications. This umbrella review aimed to evaluate the impact of different exercise interventions on patients with DPN. Methods: The search was conducted in the following databases: Pubmed, Scopus, Cochrane Library, Embase, and SPORTDiscus, from the establishment of the database up to the search date (September 11, 2023). We included systematic reviews and meta-analyses assessing exercise interventions in adults with type 1 or type 2 diabetes and DPN. Studies were selected based on predefined PICO criteria. The methodological quality of included reviews was assessed using the AMSTAR-2 tool. Results were synthesized narratively and categorized by exercise type and health outcome. Results: Fourteen reviews were included, examining the effects of various exercise interventions. Duration ranged from one week to 12 months, and studies were conducted in multiple countries. Additionally, we extracted and reanalyzed individual results from 70 primary studies included within the reviews. Some meta-analyses reported significant improvements in fasting glucose and HbA1c (n = 1), neuropathic symptoms (n = 3), physical function (n = 1), static and dynamic balance (n = 2), range of motion (n = 1), and fear of falling (n = 1). No significant effects were found for BMI, ulcer incidence, adverse events, weight-bearing activity, quality of life, or forefoot plantar pressure (n = 1). Outcome assessment tools included the Biodex system (n = 9), single-leg stance (n = 8), Berg Balance Scale (n = 11), and Timed Up and Go (n = 13) for balance; nerve conduction velocity (n = 8), MNSI (n = 6), and Total Symptom Score (n = 3) for nerve function; fasting glucose (n = 3) and HbA1c (n = 5) for glycemic control. Other outcomes included muscle strength (n = 6), functional capacity (n = 6), pain (n = 6), and quality of life (n = 6). Conclusions: Exercise training appears to have potential benefits for certain aspects of DPN, neuropathic symptoms, and functional capacity. However, the effects on glycemic control, fall risk reduction, and ulcer prevention remain inconclusive, with significant variability in study outcomes.

Patients with diabetes mellitus are exposed to important complications. Currently little evidence exist on the guidelines that these patients, at some risk of foot ulceration, should follow for physical exercise. To reach a consensus among multidisciplinary and international experts on physical activity/exercise recommendations for patients with diabetes, according to foot ulcer risk. Using a three-round Delphi method, a panel composed of 28 multidisciplinary experts in the management of diabetic foot assessed 109 recommendations on physical activity/exercise for patients with diabetes mellitus, according to their risk of foot ulcer. Consensus was assumed when 80% of responses matched the same category (agreement/disagreement). Twenty-nine experts participated in the first and second rounds of consultation, and twenty-eight did so in the third, reaching final agreement on 86 of the 109 recommendations considered (78.9%). The study, thus, generated a consensus set of recommendations concerning different aspects of diabetic footcare before, during, and after exercise (e.g. when to examine the foot, how to assess it, what type of sock and insole to use, what types of exercise to perform, and when it is advisable to return to activity after an ulceration). This Delphi study generated recommendations based on the consensus of international experts on physical activity and exercise by patient with diabetes at risk of ulceration. Recommendations considered the state of the foot and the patient's history and status before physical activity and included information on intensity, duration, frequency, and progressions of physical activity/exercise, and the use of custom-made plantar orthoses, shoe prescription, and the convenience of returning to physical activity after an ulceration.

Patients with diabetes mellitus are exposed to important complications, such as diabetic neuropathy or peripheral vascular disease. The evidence on the guidelines that these patients, with a certain risk of suffering foot ulcerations, should follow before, during and after physical exercise is scarce. The objective of this study is to identify the physical exercise guidelines to recommend based on the risk of the foot of the patient with diabetes through a consensus of experts. A three-round Delphi study will be conducted. A scientific committee (multidisciplinary group of four national experts) will review the proposal of experts and the Delphi questionnaire before submitting. A group of experts in the management and approach of the diabetic foot of an international and multidisciplinary nature will form the panel of experts, who must express their degree of (dis)agreement with each of the statements contained in the Delphi questionnaire. The percentage will be calculated in response categories, and a cut-off point of 80% will be set to define the consensus of (dis)agreement of the panelists. The results of the study could provide a series of recommendations on the realization of physical exercise in diabetic patients at risk of suffering foot ulcerations.

The aim of study is to examine the factors that may influence pain, disability and the limitation of activity due to the presence of fibromyalgia in the foot. 323 patients diagnosed with fibromyalgia were recruited. Each participant completed the Foot Function Index questionnaire (FFI) and the Revised Fibromyalgia Impact Questionnaire (FIQR). A multivariate analysis was performed to determine the factors associated with high scores in each of these questionnaires. In both questionnaires, the subscales presenting the highest scores were foot pain (FFI score: 71.18 ± 20.40) and symptom intensity (FIQR score: 36.23 ± 8.04). According to the multivariate analysis, foot function is influenced by age (p = <0.001), BMI (p = 0.001), lack of physical activity (p = <0.001), the presence of rheumatoid arthritis (p = 0.012), retirement due to disability (p = <0.001) and being unemployed (p < 0.001). Fibromyalgia affects foot function, provoking significant pain. Related factors include age, BMI, lack of physical activity, the presence of rheumatoid arthritis, and employment status.

Background: Descriptions of the techniques for condylectomies via minimally invasive surgery (MIS) to treat interdigital helomas of the lesser toes are scarce in the literature. This study aimed to define and describe this surgical technique.Methods: This observational study was performed using the Delphi method. We collected the anonymous opinions of a multidisciplinary international panel of ten experts by answering a 43‐items questionnaire via e‐mail. Statements with an average score ≥ 3 were included in the next round, as were those in which none of the three statements reached the minimum score of 3 within the same item.Results: Response rate: 90%. Three rounds were needed to reach consensus on proposed items. A new statement that combined two statements was proposed in round 3. Eleven recommendations regarding the incision and instruments used to perform this surgical technique were obtained based on the expert consensus.Conclusions: A longitudinal incision to the distal pulp of the toe or an incision to the centre of the plantar aspect of the head of the proximal phalanx should be performed according to the affectation, and a Beaver 64 scalpel blade, a blunt elevator and a Shannon‐Isham burr are the most acceptable tools for this kind of surgery.

Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.