AANEM News Express

AANEM News Express

Backward Walking Therapy for Diabetic Peripheral Neuropathy

Zhang X, Zhang Y, Gao X, et al. “Investigating the Role of Backward Walking Therapy in Alleviating the Plantar Pressure of Patients with Diabetic Peripheral Neuropathy." Archives of physical medicine and rehabilitation 2014. 95:832-9
Submitted by Ileana Howard, MD

Diabetic peripheral neuropathy is a common and costly condition, often leading to significant morbidity, including pain and foot ulcerations. Backward walking is a technique commonly employed in physical therapy because it provides unique challenges to the muscles of the lower extremities. It has been found to be useful for improving balance and gait parameters in healthy populations as well as those with musculoskeletal injuries or neurologic impairments. It has not previously been studied in populations with diabetic neuropathy.

In this study, 60 individuals with diabetic peripheral neuropathy were randomized to receive 12 weeks of backward walking therapy three times per week plus alpha-lipoic acid infusions or alpha-lipoic acid infusions alone. Therapy sessions consisted of 20-40 minutes of backward walking. In addition, all participants received intravenous infusions of 600mg alpha-lipoic acid in sodium chloride  daily for two weeks. Diabetic control also was optimized for all participants with oral hypoglycemics or insulin (pre-intervention average hemoglobin A1C values for all patients were 8.1-8.2%).

Before and after the intervention period, dynamic plantar pressures were measured with a commercially available force measurement plate. In addition, subjective pain, numbness, and tingling as well as tendon reflexes were assessed pre- and post-intervention. The intervention group demonstrated significant decreases in forefoot plantar pressures, more evenly distributed plantar pressures among the 10 regions tested, and significant improvement in subjective symptoms and tendon reflexes in comparison with the control group.


The potential to normalize plantar pressure distribution is important for potentially decreasing the risk of diabetic ulcers; however, long-term outcomes of this intervention were not assessed in this study. Currently, therapeutic interventions to address the subjective symptoms of pain and dysthesthesias are limited, and this study suggests another promising tool which can be employed as part of a comprehensive treatment program for persons with diabetic neuropathy. Further studies with more focused intervention (backward walking versus forward walking and no additional medication interventions) would be helpful to confirm these results.

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