Nurse-Led Foot-Ankle Exercises and Changes in Neuropathy Symptoms and Diabetic Foot Risk Indicators: A...

To examine whether a nurse-led foot-ankle flexibility and resistance exercise programme, delivered alongside usual care, was associated with changes in neuropathy symptoms and diabetic-foot risk/self-care indicators among adults with diabetes.

Diabetic peripheral neuropathy (DPN) contributes to reduced protective sensation, limited joint mobility and impaired self-care, increasing DFU risk. Low-cost exercise programmes targeting foot-ankle mobility and strength may improve neuropathy-related symptoms and modifiable DFU risk factors, but practice-based evidence in routine nursing settings remains limited.

Quasiexperimental, nonrandomized, nonequivalent control-group pre-post study.

Adults with Type 1 or Type 2 diabetes attending an outpatient diabetes clinic were recruited by convenience sampling (N = 60) and allocated to an intervention group (usual care plus structured exercise education and supervised practice; n = 30) or a control group (usual care; n = 30). Outcomes were assessed at baseline and 1 month using the Neuropathy Total Symptom Score-6 (NTSS-6) and the Diabetes Foot Assessment/Risk Screening scale. Because allocation was nonrandomized and outcomes were analysed in categories, inferential analyses were exploratory and based on chi-square/Fisher's exact tests with Cramer's V effect sizes.

At 1 month, neuropathy symptom severity categories differed significantly between groups (χ ² = 34.236 and p < 0.001; V = 0.76), with a greater proportion of participants in the intervention group shifting to lower symptom-severity categories. Diabetes Foot Assessment/Risk Screening categories also favoured the intervention group (χ ² = 30.762 and p < 0.001; V = 0.72). Given the quasiexperimental design and unadjusted categorical analyses, these findings should be interpreted as associations rather than causal estimates.

In this practice-based quasiexperimental study, a brief nurse-led foot-ankle flexibility and resistance exercise programme was associated with improved neuropathy symptom categories and more favourable diabetic-foot risk/self-care indicators over 1 month. The findings support feasibility within nursing practice, but causal inference is limited by nonrandom allocation, the use of categorical unadjusted analyses and the use of a study-specific foot-risk/self-care measure.

Nurses can integrate brief foot screening with structured foot-ankle exercise education and demonstration during outpatient diabetes visits as an adjunct to, not a replacement for, standard diabetic-foot surveillance and self-management support.