The early symptoms of a diabetic foot include pain, discoloration, loss of sensation, poor balance, and a “pins and needles” feeling.

As the disease advances, there is an ever-increasing vulnerability to soft-tissue wounds that develop into nonhealing ulcers and infections.

At their worst, chronic infections like these can lead to gangrene and amputations. Concurrent to the soft tissue vulnerability is a very high rate of notably severe foot deformities such as hallux valgus, bunions, corns and calluses, and hammer toes.

The central issue is the progressive loss of the oxygenation that is necessary for tissues to heal.

Over time, the diabetic foot follows the sequence of venous stasis, poor circulation, capillary breakdown, and, ultimately, soft tissue necrosis.

What causes a diabetic foot?

All of these issues are worsened by maladapted foot function.

Lower leg muscle function, which is essential for venous blood return, is poor to absent in maladapted feet. Healthy lower leg muscles normally act as muscular ‘pumps’ for venous blood return.

Maladapted foot function also exhibits an inefficient and unstable arch system. Instability increases excessive foot movement in a shoe, which imposes inappropriate pressure at localized points along with rubbing and friction to generate “hot spots” that are the precursor to the formation of ulcers.

When maladapted neuromuscular function is present, especially concurrent with the metabolic vulnerabilities of diabetes, the serious consequences of deformity and soft tissue necrosis are almost inevitable.

The Diabetic Foot

For proper function, our feet require the Right Stimulus and the Right Movement.

Right Stimulus consists of the subtle varied stimulus that the soles of our feet receive when we walk, especially when we walk barefoot on natural terrain. With each step, there are subtly different sensations.

These subtle differences in stimulus keep our brain on high alert so that our body’s protective reflexes function properly with optimal muscle function.

When our brain is uncertain about what will happen, it triggers protective reflex muscle activations that support our arches before our feet contact the ground to ensure that our feet and legs can safely manage the forces generated by the activity intensity of our bodies.

As activity-related stimulus intensifies, a progressively higher arch is created. That is why, when they are functioning properly, our arches and toes rise and fall dynamically in response to the varying activity stimulus intensities. This uninhibited dynamic movement is Right Movement.

Right Stimulus and Right Movement prevent the maladapted neuromuscular function that exacerbates diabetic foot dysfunction. They also ensure optimal muscle function and the corresponding blood flow.

Right Stimulus
Soft Cushy Insole

Conventional footwear impairs optimal foot function in two ways:

First, most conventional footwear dampens Right Stimulus.

This is particularly true for shoes or insoles that support or cushion our feet. They spread the forces evenly across the soles of our feet, creating sensory input that is muted and repetitive, step after step.  Within a short period of time, our brain tunes out the stimulus and stops responding to it.

As a result, our brain does not sufficiently activate the muscles that stabilize our arches and properly align our feet, legs, hips, and lower back, before our feet contact the ground. This “tuned-out” brain response is natural and happens all the time. For example, the same thing happens when we walk into a room and first smell coffee that we no longer notice after only a few minutes.

Second, most conventional footwear, especially footwear that is tightly laced with snug toe boxes or stiff midsoles or outsoles, restricts the Right Movement dynamic raising of the arches and toes that is critical in the creation of a strong stable arch system and healthy linear propulsion with the toe off forces spread across the forefoot.

Tight, restrictive footwear also hinders peripheral circulation leading to compression, friction, and sites of tissue stress, which can, in turn, escalate to non-healing wounds.

For the diabetic individual, impaired Right Stimulus and Right Movement will notably increase the risk of foot deformities, inadequate blood flow, and nonhealing wounds.

Conventional treatment methods for the diabetic foot include:

  • Supportive products such as orthotics
  • Taping
  • Meticulous cleaning, drying, nail trimming
  • The use of rigid ‘protective’ footwear
  • Avoidance of barefoot walking
  • Surgical procedures
Diabetic Foot

While these methods may temporarily alleviate symptoms, they don’t address the poor neuromuscular function that is the cause of the problem. In fact, the more we artificially support or cushion our feet, the weaker and the more dependent we become on these types of products.

These “old school” support and cushioning treatment methods are not recommended in any other area of musculoskeletal medicine as a viable long-term treatment option.
In fact, modern treatment methods for poor neuromuscular function focus on increasing mobility, muscle strength, and proper alignment via Proper Technique exercise, which requires both Right Stimulus and Right Movement. Science has shown that simply challenging the body to “do its job” is the best way to restore and enhance function.

This principle is the foundation for virtually all of today’s sports training/rehabilitation programs.

Recommendations to address the poor neuromuscular function that causes a diabetic foot and prevents it from reoccurring:

  • Walking barefoot on natural terrain as much as possible. This provides the optimal Right Stimulus and allows for the Right Movement required for healthy neuromuscular function.
  • To obtain Right Stimulus in your conventional footwear, use BioPods® Stimsoles® and, for best results, use them in loosely laced, soft, flexible footwear that allows your arches and toes to rise easily.
  • Consult with your healthcare practitioner to ask about employing soft tissue mobilization therapies to address the fibrotic scar tissue that may have formed, prior to using BioPods products.