Free
The Somatic Connection  |   October 2016
Manual Therapy Shown To Improve Diabetic Foot Ulcer Healing
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   October 2016
Manual Therapy Shown To Improve Diabetic Foot Ulcer Healing
The Journal of the American Osteopathic Association, October 2016, Vol. 116, 685-686. doi:10.7556/jaoa.2016.135
The Journal of the American Osteopathic Association, October 2016, Vol. 116, 685-686. doi:10.7556/jaoa.2016.135
Joseph LH, Paungmali A, Dixon J, et al. Therapeutic effects of connective tissue manipulation on wound healing and bacterial colonization count among patients with diabetic foot ulcer [published online February 2, 2016]. J Bodyw Mov Ther. 2016. doi.org/10.1016/j.jmbt.2016.01.010. 
Physical therapy researchers in Thailand and Malaysia studied the effects of connective tissue manipulation on patients with diabetic foot ulcer. Connective tissue manipulation is a manual therapy technique developed in Germany in the 1930s that uses fingertip strokes to stretch both elastic and viscous components of tissues in therapeutic reflex zones that share the same segmental innervations with the connective tissue zones. This technique stimulates parasympathetic function, resulting in reflex vasodilation and increased circulation to the peripheral extremities. For this intervention, contact was made over the arterial zone of the legs, which is around the sacrum and borders of the iliac crest. From the osteopathic perspective, this intervention appears to be an application of somatovisceral reflex theory and the manually guided forces most similar to the osteopathic manipulative procedures of the Fascial Distortion Model.1 
Inclusion criteria for this study included fasting blood glucose ≥110 mg dL-1, blood glucose 2 hours after glucose load ≥180 mg dL-1, and the presence of a noninfected diabetic foot ulcer on the plantar aspect of the foot with Wagner classification of grade 1 and 2 (skin ulcer). Exclusion criteria included patients with current hemodialysis, surgical history of lower limb revascularization, bleeding disorders, glycosylated hemoglobin more than 9%, and the use of immunosuppressant agents. 
Twenty patients with a diagnosis of type II diabetes mellitus completed the study. Each participant received conventional treatment for diabetic foot ulcer, and 10 received connective tissue manipulation, in addition to the conventional treatment, twice per week for 6 weeks. 
The outcome measures, which were collected before and after the interventions, were percentage of wound healing area and bacterial colonization count. Baseline percentage of wound healing area and bacterial colonization count were not significant between groups. Although paired t tests showed a significant percentage of improvement in wound healing area for both groups after 6 weeks (P<.05), the percentage of wound healing area was 57% in the connective tissue manipulation group and 28% in the control group. Likewise, the bacterial colonization count in both groups showed significant improvement (P<.05). However, the connective tissue manipulation in addition to conventional treatment led to a 6.4% mean reduction of bacterial burden on the wound surface compared with only 3.5% reduction in the group that received conventional treatment only. This bacterial colonization count reduction in the group that received connective tissue manipulation was significantly greater and clinically significant. These results suggest that osteopathic manipulative treatment may be applicable in the management of diabetic foot ulcer. 
References
Typaldos S. Clinical and Theoretical Application of the Fascial Distortion Model: Within the Practice of Medicine and Surgery. 4th ed. Orthopathic Global Health Publications; 2002.