Walking Bike as an Effective Tool to Reduce Plantar Peak Pressure in Diabetes Mellitus

Foot ulcers and infections are a major and costly problem in patients with diabetes and a major cause of amputations. Plantar peak pressure plays an essential role in plantar ulceration. Off-loading is a common tool to reduce plantar peak pressure and risk of ulceration. The goal of this study was to determine whether reduction of plantar peak pressure can be achieved using a walking bike (a bike without pedals) compared with walking.

The study starts with a PubMed literature review. In a blinded prospective protocol, 14 healthy individuals (seven men, seven women; mean ± SD age, 39.5 ± 11.3 years) are included. In-shoe pedobarography sensors were attached between the skin and the standardized shoes, then participants walked 10 m three times and then moved over the same distance using a walking bike without removal of the sensor (three times) in a gait laboratory (84 measurements).

In this single-blinded prospective study, mean ± SD plantar peak pressure was significantly reduced from 49.4 ± 12.9 N/cm2 with walking to 35.2 ± 14.6 N/cm2 using a walking bike (P = .003). Mean ± SD step length increased significantly from 0.68 ± 0.13 m to 0.91 ± 0.19 m (P < .001) due to a significantly reduced number of steps (from 7.7 ± 1.4 steps per 10 m of walking to 5.7 ± 1.1 steps per 10 m of using a walking bike; P < .001).

Plantar peak pressure is a risk factor for ulceration in diabetes. Herein, a significant reduction of plantar peak pressure was seen using a walking bike compared with walking (P = .003). Walking bikes may be a tool for off-loading for diabetic patients, especially if both feet are ulcerated. Additional studies to validate these findings in patient care are planned.