Effect of Buerger-Allen exercise on wound healing in patients with diabetic foot ulcers: a randomised controlled trial

Objective: A diabetic foot ulcer (DFU) is a complication of type 2 diabetes that is difficult to treat. Buerger-Allen exercise has shown effectiveness in improving foot circulation and neuropathy in several studies; however, to the best of our knowledge, no randomised controlled study has investigated its effectiveness for DFU healing. Therefore, this study aimed to assess the effects of Buerger-Allen exercise on the healing of DFUs in patients with type 2 diabetes. Method: This is a parallel-group randomised controlled trial (RCT). Of 50 patients with neuropathic DFUs, 41 completed the study. They were assigned randomly to a study group (n=21) and a control group (n=20). Patients in the study group received the standard medical treatment and semi-supervised Buerger-Allen exercise for three sessions per week for four weeks, while patients in the control group only received the standard medical treatment. The outcome measures were: ankle-brachial pressure index (ABPI); ulcer size; ulcer depth; SINBAD score; and ulcer risk for poor outcomes (based on the SINBAD score). Results: The study group's mean age was 49.48 +/- 6.45 years and the control group's mean age was 49.15 +/- 5.85. The study group's ABPI increased significantly compared to the baseline (1.17 +/- 0.04 versus 1.11 +/- 0.05, respectively; p<0.001) and the control group (1.17 +/- 0.04 versus 1.14 +/- 0.05, respectively; p=0.04) post-intervention. Ulcer size also reduced significantly in the study group compared to the baseline (2.63 +/- 2.0 versus 7.48 +/- 5.55cm(2), respectively; p<0.001) and the control group (2.63 +/- 2.0 versus 6.43 +/- 4.45cm(2), respectively; p<0.001) post-intervention. Ulcer depth decreased significantly in the study group compared to the baseline (1.71 +/- 1.05 versus 4.19 +/- 1.74mm, respectively; p<0.001) and the control group (1.71 +/- 1.05 versus 2.80 +/- 1.57mm, respectively; p=0.01) post-intervention. Furthermore, the SINBAD score in the study group decreased significantly compared to the baseline (1.38 +/- 0.86 versus 2.14 +/- 1.06, respectively; p<0.001) and the control group (1.38 +/- 0.86 versus 2.0 +/- 0.79, respectively; p=0.02) post-intervention. Moreover, the ulcer risk for poor outcomes, based on the SINBAD score, reduced significantly only in the study group, compared to the baseline (p=0.041). The control group showed non-significant changes compared to the baseline in all outcome measures (p>0.05). Conclusion: From the findings of this RCT, Buerger-Allen exercise, in combination with standard wound care, may help accelerate the healing of neuropathic DFUs in patients with type 2 diabetes, and could be suggested as part of the management plan for such conditions as an easy-to-perform offloading exercise intervention. Declaration of interest: The authors have no conflicts of interest to declare.