Walking bikes may prevent or heal foot ulcers among diabetic patients, finds study

Diabetic foot ulcers are a serious complication of the disease and are frequent and costly, often leading to infection and even amputation in extreme cases. A major factor contributing to plantar ulceration is increased plantar peak pressure. Off-loading methods, which include special footwear, seek to minimize this pressure. The goal of the present study was to examine if a walking bike can be an alternative method for off-loading to reduce plantar peak pressure. Walking bikes allow forward locomotion without having to support the full body weight with one's feet and, therefore, may be very useful for patients with active ulcers on both feet.

The literature on the topic was reviewed extensively using PubMed. A blinded prospective protocol was used on 14 apparently healthy persons made of seven men and seven women with a mean age of 39.5 ± 11.3 years. Plantar peak pressure was measured by using in-shoe pedobarography sensors. Sensors were inserted between participants' skin and standardized shoes. Each participant walked 10 meters three times and then covered an equivalent distance using a walking bike without removing the sensors. A total of 84 measurements were obtained in the sessions performed in the gait laboratory.

Main Results

• The study showed that with the use of the walking bike, the plantar peak pressure significantly decreased as compared to walking.

• Plantar peak pressure averaged 49.4 ± 12.9 N/cm² during walking compared with 35.2 ± 14.6 N/cm² with the use of a walking bike (P = 0.003).

• This reduction is clinically significant because lower plantar pressures are associated with reduced risk of ulceration in diabetic patients.

• Furthermore, the walking bike significantly affected step length. Patients extended their average step length from 0.68 ± 0.13 to 0.91 ± 0.19 meters (P < 0.001). The patients were able to walk with longer steps since the number of steps per 10 meters was reduced compared with walking, from 7.7 ± 1.4 to 5.7 ± 1.1 steps when using the walking bike (P < 0.001).

The healthy participants studied herein provide a preliminary overview of the advantages of walking bikes in terms of relief from plantar peak pressure. However, to establish this as fact, replication of the research on diabetic patients with foot ulcers is recommended. Subsequent research in this area should test the long-term clinical efficacy of walking bikes with respect to healing rates and other indicators of general foot health in diabetic subjects.

This study thus shows that the walking bike reduces plantar peak pressure significantly and thus presents a promising tool for off-loading in diabetic patients at risk of foot ulcers. For patients with bilateral foot ulcers in particular, use of the walking bike offers an effective alternative to current off-loading strategies. Further studies are required to confirm the effectiveness of the use of walking bikes both in the care of diabetic patients and in preventing ulcers.

Reference:

Illgner, U., Mehlhorn, A., Osada, N., Krenn, V., & Landauer, F. (2024). Walking bike as an effective tool to reduce plantar peak pressure in diabetes mellitus. Journal of the American Podiatric Medical Association, 114(4). https://doi.org/10.7547/22-127