Effects of diabetic foot school on sensation, balance and lower extremity biomechanics

This study aims to establish a Diabetic Foot School to prevent the progression of the disease in diabetic foot patients and to compare the effects of this education on sensory perception, balance, and lower extremity biomechanics in individuals. A total of 24 participants aged between 40 and 70 were included in our study. The participants were randomly divided into two groups: the treatment group and the control group. The control group attended Diabetic Foot School sessions once a week for eight weeks, while the treatment group participated in Diabetic Foot School sessions once a week for eight weeks and additionally received individual foot exercise training twice a week in-person and once a week via online telerehabilitation. Each week, participants' pain severity was assessed before and after the sessions using the Visual Analog Scale. Additionally, various parameters were evaluated before and after the eight-week program: neuropathic pain using the Neuropathic Pain Questionnaire, plantar pressure with a monofilament, vibration sensation with a tuning fork, proprioception with a digital inclinometer, muscle strength with a hand dynamometer, lower extremity strength with the stair climb test, balance with the Timed Up and Go test and the Functional Reach Test, and gait spatiotemporal characteristics using a gait sensor. Pedobarographic measurements were conducted with a foot pressure measurement device. Furthermore, participants' knowledge about diabetic foot care was assessed using the "Diabetic Foot Care Behavior Scale," the "Diabetic Foot Knowledge Scale," and the "Diabetic Foot Care Self-Efficacy Questionnaire." Post-treatment results showed significant improvements (p<0.05) in pain indicators, plantar pressure, proprioception, gait cadence, balance, and diabetic foot knowledge scores in both groups according to the neuropathic pain questionnaire. Only the Treatment Group demonstrated significant improvements (p<0.05) in lower extremity strength, including left hip flexors, right hip extensors, knee flexors and extensors, and foot-ankle muscle strength. In addition, it was observed that the center of pressure (COP) displacement and gait velocity values improved. As a result, it was found that the Diabetic Foot School had significant effects on individuals' sensory perception, balance, gait, and knowledge about diabetic foot care. Considering our findings, it has been observed that education programs, particularly those supported by exercise, lead to more comprehensive and effective improvements in diabetic foot patients. These results strongly support the widespread implementation of such training programs for all individuals with diabetes. We believe that the Diabetic Foot School training can be beneficial for both diabetic patients and those with diabetic foot.