Physical therapy in wound care and in the prevention of diabetic foot amputation: A narrative review
DOI:
https://doi.org/10.62827/fb.v27i7.1244Keywords:
Diabetic Foot; Physical Therapy Modalities; Wound Healing; Diabetic Neuropathies; Secondary Prevention.Abstract
Introduction: Foot ulceration precedes most nontraumatic lower limb amputations in people with diabetes, yet the contribution of physical therapy is described in a fragmented way. Objective: To describe the role of physical therapy in wound care and in the prevention of diabetic foot amputation. Methods: Descriptive and qualitative narrative review, with a structured search carried out between June and August 2026 in the Medical Literature Analysis and Retrieval System Online database, accessed through PubMed, with retrieval of guidelines and reference tracking. Free terms in English were combined with the operators AND and OR, prioritising publications from 2021 to 2026, in Portuguese and English. Randomised trials, reviews, observational studies and guidelines related to physical therapy practice were included; case reports, editorials, letters and conference abstracts were excluded. Selection followed two stages and the studies were analysed descriptively, by thematic axes. Results: Sixty-nine studies were included. The most robust evidence supports nonremovable offloading devices; therapeutic footwear shows a favourable effect, whereas structured education shows a favourable direction, with low to very low certainty. In the foot and ankle exercise trials, function, range of motion and gait improved, with no trial adopting ulcer incidence as an outcome. Electrophysical agents show a favourable direction with low certainty, and rehabilitation after amputation rests on an extremely scarce evidence base. Conclusion: The contribution of physical therapy lies in managing mechanical load and function throughout the disease cycle, rather than in agents applied to the wound.
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