Skip to main content

Advertisement

SpringerLink
Log in

Psychological and Biomechanical Aspects of Patient Adaptation to Diabetic Neuropathy and Foot Ulceration

  • Microvascular Complications—Neuropathy (R Pop-Busui, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review was to elucidate how psychological and biomechanical factors interrelate in shaping patients’ experience with diabetic symmetric polyneuropathy (DSPN) and its sequela-diabetic foot ulceration (DFU).

Recent Findings

Recent findings emphasize the importance not only of neuropathic pain but also of other DSPN symptoms, such as unsteadiness. We highlight the negative spiral between unsteadiness, falls, and psychological distress. Moreover, unsteadiness is a key determinant of non-adherence to offloading resulting in the delayed DFU healing. While depression is an established predictor of incident DFU, findings linking depression and DFU healing remain inconclusive. Examination of physical activity in DFU development and healing represents the most recent application of research to this field.

Summary

Research evidence indicates that DSPN markedly impairs physical and emotional functioning and suggests that there is an unmet need for the development of multifaceted interventions that address both psychological distress and biomechanical challenges experienced by patients with this debilitating complication of diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136–54. A comprehensive review of diagnostic tools and treatment options for diabetic neuropathies.

    Article  PubMed  Google Scholar 

  2. •• Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People with Diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40. Evidence-based guidelines for psychosocial assessment and care of patients with diabetes and their families.

    Article  PubMed  Google Scholar 

  3. • Vileikyte L, Leventhal H, Gonzalez JS, Peyrot M, Rubin RR, Ulbrecht JS, et al. Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care. 2005;28(10):2378–83. An important paper defines pathways linking distal symmetric polyneuropathy to depressive symptoms.

    Article  PubMed  Google Scholar 

  4. Vileikyte L, Peyrot M, Gonzalez JS, Rubin RR, Garrow AP, Stickings D, et al. Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia. 2009;52(7):1265–73.

    Article  CAS  PubMed  Google Scholar 

  5. • Crews RT, Shen BJ, Campbell L, Lamont PJ, Boulton AJ, Peyrot M, et al. Role and determinants of adherence to off-loading in diabetic foot ulcer healing: a prospective investigation. Diabetes Care. 2016;39(8):1371–7. This study objectively demonstrates the association between off-loading adherence and diabetic foot ucler healing and identifies self-reported unsteadiness as a significant predictor of adherence to offloading.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Gore M, Brandenburg NA, Hoffman DL, Tai KS, Stacey B. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain. 2006;7(12):892–900.

    Article  PubMed  Google Scholar 

  7. • Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai KS, Stacey B. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manag. 2005;30(4):374–85. A thorough overview of neuropathic pain burden.

    Article  Google Scholar 

  8. Selvarajah D, Cash T, Sankar A, Thomas L, Davies J, Cachia E, et al. The contributors of emotional distress in painful diabetic neuropathy. Diab Vasc Dis Res. 2014;11(4):218–25.

    Article  PubMed  Google Scholar 

  9. Padua L, Aprile I, Saponara C, Padua R, Ghirlanda G, Pauri F, et al. Multiperspective assessment of peripheral nerve involvement in diabetic patients. Eur Neurol. 2001;45(4):214–21.

    Article  CAS  PubMed  Google Scholar 

  10. Ahroni JH, Boyko EJ. Responsiveness of the SF-36 among veterans with diabetes mellitus. J Diabetes Complicat. 2000;14(1):31–9.

    Article  CAS  PubMed  Google Scholar 

  11. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology. 2007;68(15):1178–82.

    Article  PubMed  Google Scholar 

  12. Vickrey BG, Hays RD, Beckstrand M. Development of a health-related quality of life measure for peripheral neuropathy. Neurorehabil Neural Repair. 2000;14(2):93–104.

    Article  CAS  PubMed  Google Scholar 

  13. Vinik EJ, Hayes RP, Oglesby A, Bastyr E, Barlow P, Ford-Molvik SL, et al. The development and validation of the Norfolk QOL-DN, a new measure of patients’ perception of the effects of diabetes and diabetic neuropathy. Diabetes Technol Ther. 2005;7(3):497–508.

    Article  PubMed  Google Scholar 

  14. Vileikyte L, Peyrot M, Bundy C, Rubin RR, Leventhal H, Mora P, et al. The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument. Diabetes Care. 2003;26(9):2549–55.

    Article  PubMed  Google Scholar 

  15. Otto M, Bach FW, Jensen TS, Sindrup SH. Health-related quality of life and its predictive role for analgesic effect in patients with painful polyneuropathy. Eur J Pain. 2007;11(5):572–8.

    Article  PubMed  Google Scholar 

  16. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.

    Article  PubMed  Google Scholar 

  17. Asmundson GJ, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26(10):888–901.

    Article  PubMed  Google Scholar 

  18. Tesfaye S, Vileikyte L, Rayman G, Sindrup SH, Perkins BA, Baconja M, et al. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. 2011;27(7):629–38.

    Article  CAS  PubMed  Google Scholar 

  19. Marchettini P, Wilhelm S, Petto H, Tesfaye S, Tolle T, Bouhassira D, et al. Are there different predictors of analgesic response between antidepressants and anticonvulsants in painful diabetic neuropathy? Eur J Pain. 2016;20(3):472–82.

    Article  CAS  PubMed  Google Scholar 

  20. Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Rekeneire N, Strotmeyer ES, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31(3):391–6.

    Article  PubMed  Google Scholar 

  21. DeMott TK, Richardson JK, Thies SB, Ashton-Miller JA. Falls and gait characteristics among older persons with peripheral neuropathy. Am J Phys Med Rehabil. 2007;86(2):125–32.

    Article  PubMed  Google Scholar 

  22. Dunn JE, Rudberg MA, Furner SE, Cassel CK. Mortality, disability, and falls in older persons: the role of underlying disease and disability. Am J Public Health. 1992;82(3):395–400.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Tan MP, Kamaruzzaman SB, Zakaria MI, Chin AV, Poi PJ. Ten-year mortality in older patients attending the emergency department after a fall. Geriatr Gerontol Int. 2016;16(1):111–7.

    Article  PubMed  Google Scholar 

  24. McKee KJ, Orbell S, Austin CA, Bettridge R, Liddle BJ, Morgan K, et al. Fear of falling, falls efficacy, and health outcomes in older people following hip fracture. Disabil Rehabil. 2002;24(6):327–33.

    Article  CAS  PubMed  Google Scholar 

  25. Kelly C, Fleischer A, Yalla S, Grewal GS, Albright R, Berns D, et al. Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy. J Am Podiatr Med Assoc. 2013;103(6):480–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hazari A, Maiya AG, Shivashankara KN, Agouris I, Monteiro A, Jadhav R, et al. Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis. Spring. 2016;5(1):1819.

    Article  Google Scholar 

  27. • Reeves ND, Brown SJ, Petrovic M, Boulton AJM, Vileikyte L. How does self-perceived unsteadiness influence balance and gait in people with diabetes? Preliminary Obs Diabetes Care. 2017;40(5):e51–e2. The study demonstrated the association between subjective (self-perceived unsteadiness) and objective (laboratory) measures of balance in people with diabetes and distal symmetrical polyneuropathy.

    Article  Google Scholar 

  28. • Brown SJ, Handsaker JC, Bowling FL, Boulton AJ, Reeves ND. Diabetic peripheral neuropathy compromises balance during daily activities. Diabetes Care. 2015;38(6):1116–22. The study objectively demonstrated impaired balance in people with diabetic neuropathy compared to controls during daily tasks such as walking on stairs.

    Article  PubMed  Google Scholar 

  29. Schwenk M, Jordan ED, Honarvararaghi B, Mohler J, Armstrong DG, Najafi B. Effectiveness of foot and ankle exercise programs on reducing the risk of falling in older adults: a systematic review and meta-analysis of randomized controlled trials. J Am Podiatr Med Assoc. 2013;103(6):534–47.

    Article  PubMed  Google Scholar 

  30. Grewal GS, Schwenk M, Lee-Eng J, Parvaneh S, Bharara M, Menzies RA, et al. Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in diabetics with peripheral neuropathy: a randomized controlled trial. Gerontology. 2015;61(6):567–74.

    Article  PubMed  Google Scholar 

  31. Handsaker JC, Brown SJ, Bowling FL, Maganaris CN, Boulton AJ, Reeves ND. Resistance exercise training increases lower limb speed of strength generation during stair ascent and descent in people with diabetic peripheral neuropathy. Diabet Med. 2016;33(1):97–104.

    Article  CAS  PubMed  Google Scholar 

  32. Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. J Am Geriatr Soc. 2004;52(9):1487–94.

    Article  PubMed  Google Scholar 

  33. Iversen MM, Midthjell K, Tell GS, Moum T, Østbye T, Nortvedt MW, et al. The association between history of diabetic foot ulcer, perceived health and psychological distress: the Nord-Trøndelag health study. BMC Endocr Disord. 2009;9:18. p. 7

    Article  PubMed  PubMed Central  Google Scholar 

  34. • Ismail K, Winkley K, Stahl D, Chalder T, Edmonds M. A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. Diabetes Care. 2007;30(6):1473–9. A report on high prevalence of clinical depression in diabetic foot ulcer patients and its association with increased mortality.

    Article  PubMed  Google Scholar 

  35. Winkley K, Sallis H, Kariyawasam D, Leelarathna LH, Chalder T, Edmonds ME, et al. Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality. Diabetologia. 2012;55(2):303–10.

    Article  CAS  PubMed  Google Scholar 

  36. • Williams LH, Rutter CM, Katon WJ, Reiber GE, Ciechanowski P, Heckbert SR, et al. Clinical research study: depression and incident diabetic foot ulcers: a prospective cohort study. Am J Med. 2010;123:748–54. An epidemiologic investigation that linked major depression to a 2-fold increased risk of incident diabetic foot ulcers.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Iversen MM, Tell GS, Espehaug B, Midthjell K, Graue M, Rokne B, et al. Is depression a risk factor for diabetic foot ulcers? 11-Years follow-up of the Nord-Trondelag health study (HUNT). J Diabetes Complicat. 2015;29(1):20–5.

    Article  PubMed  Google Scholar 

  38. • Gonzalez JS, Vileikyte L, Ulbrecht JS, Rubin RR, Garrow AP, Delgado C, et al. Depression predicts first but not recurrent diabetic foot ulcers. Diabetologia. 2010;53(10):2241–8. A prospective study of well-defined neuropathy population while confirming that depression is a risk factor for incident first foot ulcers challenges foot self-care as a mechanism linking depression to foot ulceration.

    Article  CAS  PubMed  Google Scholar 

  39. Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31(12):2398–403.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Brownlee S, Leventhal EA, Leventhal H. Regulation, self-regulation and regulation of the self in maintaining physical health. In: Boekartz M, Pintrich PR, Zeidner M, editors. Handbook of self-regulation. San Deiego: Academic Press; 2000. p. 369–416.

    Chapter  Google Scholar 

  41. • Vileikyte L, Gonzalez JS, Leventhal H, Peyrot MF, Rubin RR, Garrow A, et al. Patient interpretation of neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care. Diabetes Care. 2006;29(12):2617–24. Psychometric validation of the instument that captures characteristic misconceptions about neuropathy as the foot ulcer risk and associated emotions that shape preventive foot self-care.

    Article  PubMed  Google Scholar 

  42. Perrin BM, Swerissen H, Payne CB, Skinner TC. Cognitive representations of peripheral neuropathy and self-reported foot-care behaviour of people at high risk of diabetes-related foot complications. Diabet Med. 2014;31(1):102–6.

    Article  CAS  PubMed  Google Scholar 

  43. French DP, Wade AN, Farmer AJ. Predicting self-care behaviours of patients with type 2 diabetes: the importance of beliefs about behaviour, not just beliefs about illness. J Psychosom Res. 2013;74(4):327–33.

    Article  PubMed  Google Scholar 

  44. Arts ML, de Haart M, Bus SA, Bakker JP, Hacking HG, Nollet F. Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration. J Rehabil Med. 2014;46(4):357–62.

    Article  PubMed  Google Scholar 

  45. Waaijman R, Keukenkamp R, de Haart M, Polomski WP, Nollet F, Bus SA. Adherence to wearing prescription custom-made footwear in patients with diabetes at high risk for plantar foot ulceration. Diabetes Care. 2013;36(6):1613–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. • Crews RT, Schneider KL, Yalla SV, Reeves ND, Vileikyte L. Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes Metab Res Rev. 2016;32:791–804. A comprehensive overview of research into physical activity in patients at high risk of foot ulceration.

    Article  PubMed  Google Scholar 

  47. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–67.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mendes R, Sousa N, Reis VM, Themudo-Barata JL. Prevention of exercise-related injuries and adverse events in patients with type 2 diabetes. Postgrad Med J. 2013;89(1058):715–21.

    Article  PubMed  Google Scholar 

  49. Kanchanasamut W, Pensri P. Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study. Diabet Foot Ankle. 2017;8(1):1287239.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Dixit S, Maiya AG, Shastry BA. Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, parallel group randomized controlled trial. J Diabetes Complicat. 2014;28(3):332–9.

    Article  PubMed  Google Scholar 

  51. Dixit S, Maiya A, Shastry B. Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Qual Life Res. 2014;23(5):1629–40.

    Article  PubMed  Google Scholar 

  52. Dixit S, Maiya A, Shastry BA, et al. Analysis of postural control during quiet standing in a population with diabetic peripheral neuropathy undergoing moderate intensity aerobic exercise training: a single blind, randomized controlled trial. Am J Phys Med Rehabil. 2016;95(7):516–24.

    Article  PubMed  Google Scholar 

  53. Singleton JR, Marcus RL, Lessard MK, et al. Supervised exercise improves cutaneous reinnervation capacity in metabolic syndrome patients. Ann Neurol. 2015;77(1):146–53.

    Article  PubMed  Google Scholar 

  54. Kluding PM, Pasnoor M, Singh R, et al. Safety of aerobic exercise in people with diabetic peripheral neuropathy: single-group clinical trial. Phys Ther. 2015;95(2):223–34.

    Article  PubMed  Google Scholar 

  55. Morrison S, Colberg SR, Parson HK, et al. Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy. J Diabetes Complicat. 2014;28(5):715–22.

    Article  PubMed  Google Scholar 

  56. Mueller MJ, Tuttle LJ, LeMaster JW, et al. Weight-bearing versus nonweight-bearing exercise for persons with diabetes and peripheral neuropathy: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(5):829.

    Article  PubMed  Google Scholar 

  57. Katon WJ, Russo JE, Heckbert SR, Lin EH, Ciechanowski P, Ludman E, et al. The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes. Int J Geriatr Psychiatry. 2010;25(5):466–75.

    Article  PubMed  Google Scholar 

  58. Crews RT, Yalla SV, Fleischer AE, Wu SC. A growing troubling triad: diabetes, aging, and falls. J Aging Res. 2013;2013:342650.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complicat. 2012;26:424–9.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Yoo M, D'Silva LJ, Martin K, Sharma NK, Pasnoor M, LeMaster JW, et al. Pilot study of exercise therapy on painful diabetic peripheral neuropathy. Pain Med. 2015;16:1482–9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. •• Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: implications for health. Nat Rev Immunol. 2005;5(3):243–51. A superb overview of the effects and mechanisms by which psychological stress influences health outcomes.

    Article  CAS  PubMed  Google Scholar 

  62. • Monami M, Longo R, Desideri CM, Masotti G, Marchionni N, Mannucci E. The diabetic person beyond a foot ulcer: healing, recurrence, and depressive symptoms. J Am Podiatr Med Assoc. 2008;98(2):130–6. The first investigation linking depression to foot ulcer nonhealing and recurrence.

    Article  PubMed  Google Scholar 

  63. Vedhara K, Miles JN, Wetherell MA, Dawe K, Searle A, Tallon D, et al. Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence. Diabetologia. 2010;53(8):1590–8.

    Article  CAS  PubMed  Google Scholar 

  64. Gonzalez JS, Hardman MJ, Boulton AJ, Vileikyte L. Coping and depression in diabetic foot ulcer healing: causal influence, mechanistic evidence or none of the above? Diabetologia. 2011;54(1):205–6.

    Article  CAS  PubMed  Google Scholar 

  65. Razjouyan J, Grewal GS, Talal TK, Armstrong DG, Mills JL, Najafi B. Does physiological stress slow down wound healing in patients with diabetes? J Diabetes Sci Technol. 2017;11:685–92.

    Article  PubMed  Google Scholar 

  66. Lavery LA, Fleishli JG, Laughlin TJ, Vela SA, Lavery DC, Armstrong DG. Is postural instability exacerbated by off-loading devices in high risk diabetics with foot ulcers? Ostomy Wound Manage. 1998;44(1):26–32.

    CAS  PubMed  Google Scholar 

  67. van Deursen R. Footwear for the neuropathic patient: offloading and stability. Diabetes Metab Res Rev. 2008;24(Suppl 1):S96–S100.

    Article  PubMed  Google Scholar 

  68. Goodworth AD, Kunsman M, DePietro V, LaPenta G, Miles K, Murphy J. Characterization of how a walking boot affects balance. J Prosthetics Orthot. 2014;26(1):6.

    Article  Google Scholar 

  69. Bus SA, van Netten JJ. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable. Diabetes Metab Res Rev. 2016;32(Suppl 1):195–200.

    Article  PubMed  Google Scholar 

  70. Crews RT, Sayeed F, Najafi B. Impact of strut height on offloading capacity of removable cast walkers. Clin Biomech (Bristol, Avon). 2012;27(7):725–30.

    Article  Google Scholar 

  71. Keylock KT, Vieira VJ, Wallig MA, DiPietro LA, Schrementi M, Woods JA. Exercise accelerates cutaneous wound healing and decreases wound inflammation in aged mice. Am J Physiol Regul Integr Com Physiol. 2008;294(1):R179–84.

    Article  CAS  Google Scholar 

  72. Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise accelerates wound healing among healthy older adults: a preliminary investigation. J Gerontol A Biol Sci Med Sci. 2005;60(11):1432–6.

    Article  PubMed  Google Scholar 

  73. Pence BD, Woods JA. Exercise, obesity, and cutaneous wound healing: evidence from rodent and human studies. Adv Wound Care (New Rochelle). 2014;3(1):71–9.

    Article  Google Scholar 

  74. Pence BD, Dipietro LA, Woods JA. Exercise speeds cutaneous wound healing in high-fat diet-induced obese mice. Med Sci Sports Exerc. 2012;44(10):1846–54.

    Article  PubMed  Google Scholar 

  75. Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin N Am. 2011;31(1):81–93.

    Article  Google Scholar 

  76. Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol. 2011;11(9):607–15.

    Article  CAS  PubMed  Google Scholar 

  77. Vanross ER, Johnson S, Abbott CA. Effects of early mobilization on unhealed dysvascular transtibial amputation stumps: a clinical trial. Arch Phys Med Rehabil. 2009;90(4):610–7.

    Article  PubMed  Google Scholar 

  78. • Najafi B, Grewal GS, Bharara M, Menzies R, Talal TK, Armstrong DG. Can’t Stand the pressure: the association between unprotected standing, walking, and wound healing in people with diabetes. J Diabetes Sci Technol. 2016;11:657–67. The first investigation of the effects of physical activity on foot ulcer healing in diabetes.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Vileikyte L, Shen BJ, Brouwn S, Boulton AJM, Kirsner RS, Reeves ND, et al. Depression, Physical activity, and diabetic foot ulcer healing. American Diabetes Association’s 77th Scientific Sessions; June 9–13; San Deigo, California, USA. Diabetes. 2017;66(Supplement 1):A168.

Download references

Acknowledgements

We thank the NIH (NIDDK R01-DK-071066) for their generous support of some of the studies reported in this review.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Manchester, Manchester, M13 9WL, UK

    Loretta Vileikyte

  2. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA

    Ryan T. Crews

  3. School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK

    Neil D. Reeves

Authors
  1. Loretta Vileikyte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan T. Crews
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neil D. Reeves
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Loretta Vileikyte.

Ethics declarations

Conflict of Interest

Loretta Vileikyte and Neil D. Reeves declare that they have no conflict of interest.

Ryan T. Crews reports personal fees from Ossur Americas, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Microvascular Complications—Neuropathy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vileikyte, L., Crews, R.T. & Reeves, N.D. Psychological and Biomechanical Aspects of Patient Adaptation to Diabetic Neuropathy and Foot Ulceration. Curr Diab Rep 17, 109 (2017). https://doi.org/10.1007/s11892-017-0945-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-017-0945-5

Keywords

Search

Navigation