Exercises to Strengthen Muscles of the Feet

S.Bamila

M.V. Centre for Diabetic Foot Care, Podiatry, Research & Management

This is a set of six foot exercises to be done while you are sitting on a high seat with feet not touching the ground.

1. Bend toes down. Try to keep toes straight. You can use your hand to help position the toes or get someone to help you.

2. Raise ankle up, but keep toes down.

3. Relax the toes.

4. Flex toes down and at the same time flex ankle down. Feel a squeeze in the arch.

5 . While keeping toes flexed, move the front of the foot inward (inversion)

6. Then move the front of the foot outward (eversion). Relax.
Repeat steps 1-6


DO these FOOT EXERCISES with feet on the ground.

1. Exercise position: Sit in a chair with feet flat on the floor. Raise toes off the floor several times. Keep the ball of the foot on the floor. This exercise is important for walking and helps to keep up the normal range of movement of the toe joints.

2. Exercise position: Sit in a chair with feet flat on the floor. Slide the foot back under the chair. Raise the heel, while keeping the ball of the foot and the toes on the floor. This exercise stretches tight muscles under the foot and maintains normal range of motion of the toe joints.

3. Exercise position: Sit in a chair, with feet flat on floor. Keeping the feet and toes flat on the floor, press the toes into the floor. Keep them as straight as possible. Do not allow them to curl. This strengthens the small muscles of the toes.

4. Exercise position: Sit in a chair, with feet hanging loosely. Spread the toes far apart then squeeze together as tightly as possible. After some practice, you can put a wide rubber band around your toes and spread them against resistance, further increasing strength of the small muscles.


5. Exercise position: Sit in a chair, with feet flat on the edge of a bath towel or newspaper. Curl the toes and draw the towel/ newspaper under the foot. As you get stronger, add a weight to the other end of the towel/ newspaper. This exercise strengthens intrinsic muscles.


6. Exercise position: Sit in a chair. Place a marble on the floor, and pick it up with your toes. This exercise strengthens the small muscles of the toes.

7. Exercise position: While standing, hold lightly onto a counter top or sturdy chair for balance. Rise up onto the tips of the toes, then rock back onto the heels, lifting the toes off the floor at the same time. Do this several times. This can also be done while sitting.

This exercise improves balance and leg strength when done standing and increases foot and ankle movements and strength of the muscle.

It is important to keep this muscle strong and your ankle flexible so that you can pick up your toes when you walk, and avoid tripping.

8. Exercise position: Sit in a chair. Straighten one knee and bend the ankle. Point the toes toward the knee and feel the stretch of the calf muscle . Repeat 4 times on each leg, alternating legs. This exercise prevents cramps in the lower leg.

9. Exercise position: Sit in a chair. Move your feet as if you are writing alphabets in the air.

World Diabetes Day

Mrs. Sheela Paul

World diabetes day is celebrated on 14th of November of every year around the world, to raise primary global awareness among people about diabetes. It was introduced in 1991 by the International Diabetes Federation and the World Health Organization in response to the alarming rise of diabetes around the world. World Diabetes Day is a campaign that features a new theme chosen by the International Diabetes Federation each year to address issues facing the global diabetes community. While the campaigns last the whole year, the day itself marks the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922

Each year, World Diabetes Day is centered on a theme related to diabetes. Topics covered have included diabetes and human rights, diabetes and lifestyle, diabetes and obesity, diabetes in the disadvantaged and the vulnerable, and diabetes in children and adolescents.

For 2009–2013, the theme is Diabetes Education and Prevention.

World Diabetes day is celebrated worldwide in more than 160 countries, all member States of the United Nations, healthcare professionals and many more.

The logo of the World Diabetes day is represented by a blue circle. This blue circle resembles to the global symbol of diabetes and signifies the unity of the global diabetes community in response to the diabetes pandemic.

In large towns and metro cities, most of the people don’t eat healthy food, and also doing very less exercise, that may be the major reason of this disease. By taking proper healthy diet and regular exercise will help to control Diabetes. But frankly telling there is no permanent cure for Diabetes.



There are lots and lots of activities organized on this day. These activities includes Radio and Television Programs, Poster Awareness Campaigns, Social Exhibitions, Lightings at monuments and homes, Press Conferences, Diabetes Workshops, Screening of Documentaries films on Diabetes, Public Meeting to distribute information to general public, Sports events or Cycle Racing, Special events or activities for children and Newspaper or Magazine Articles. Every Year, this World Diabetes Day activity is center around the topics that related to diabetes.

About 285 million people from all over the world are affected by Diabetes and it is also expected that this figure may rise up to 435 million by year 2030 if no action implement to stop Diabetes. Generally, it is believed that only aged people suffer from Diabetes but several studies and instances proved that the disease does not limited to any age, anyone can be affected by Diabetes.

World Diabetes day is a call to all those who are responsible for Diabetes care and can contribute to control it. For a diabetic patient, this is a message for empowerment education so that he can follow proper ways whether diet food or exercises to improve his health. For Doctors or healthcare professionals this is an alert to improve knowledge so that proper cure can be discovered. For government, it is a time to implement proper policies for prevention of diabetes. And for general public this is a call to be alert against Diabetes and understand the serious impact of diabetes.





However, if you have diabetes, you also can live a normal, productive life. It's important, though, to monitor your diabetes and be active in taking good care of your health by recognising its symptoms properly at the right time. In last, we would like to add ‘Prevention is better than cure’, as there is no need for any cure if we take proper steps and stay away from these kind of diseases through proper prevention.

Socio-Cultural Changes and Diabetes

With India being dubbed the ‘Diabetes capital of the world’ it is necessary to understand the reasons that contribute to it, the changes it brings about in an individual’s life and explore ways to tackle them.

Great social and cultural changes have taken place in our society. The relatively simple and austere life style of our forefathers has given way to a lavish one where there is no limit to what money can buy.

People don’t exert themselves. The benefits of labour- saving devices and automated transport have forced people to reduce their levels of physical activity.


Easy access to mass produced refined high calorie foods which are affordable and heavily advertised have resulted in an increase in food consumption which is far more than what the body needs.

The fast pace of modern life ,changing values , longer working hours, and changes in family responsibilities have adversely influenced eating patterns and time spent on recreation and outside activities.


As a result, life style diseases such as diabetes, cardiac conditions, obesity, and circulatory problems are fast approaching epidemic proportions.

The three most important risk factors for Type 2 diabetes are sedentary life style,



poor dietary habits


and , the ensuing changes in body composition.


These are risks that can be avoided.

A person with diabetes has to get used to changes in lifestyle, has to adhere strictly to the treatment and also has to be prepared for the onset of diabetes related complications. So, prevention is better than cure.

Changes in the life of a T2DM

High blood glucose levels and poor control can result in medical complications such as cardio-vascular diseases, retinopathy, neuropathy, and nephropathy.


Apart from that, it can influence many areas of a person’s life – changes in the daily routine due to activities focused on adequate blood glucose control, ability to work, impact on other members of the family, quality of life, sexual functioning and so on.

Diet and exercise, blood glucose monitoring, timing and dosage of oral medication or insulin, hypo management and prevention, foot care, sick day management, visits to the doctor,


medical checks and education activities


– all these have to be integrated into the normal day-to-day activities of people with diabetes.


In addition, they may have to tackle unexpected crises.

In most cases, Type 2 diabetes shows up in middle adulthood. This is a time when behavior patterns of an individual are firmly set and changes for self- care have to be made to improve blood glucose control and to slow down the advancement of diabetic complications. It may require a lot of effort to make the necessary changes. It is difficult to make changes to food habits and even more challenging to maintain them.

During the time before complications set in or during the early period of complications, many people do not show symptoms. Unpleasant symptoms such as slow healing wounds or ulcers, thickening and narrowing of arteries, tingling or burning sensation in hands, legs and feet, protein in urine, or poor vision are usually followed by an awareness and fear of the seriousness of the disease . When they are absent, the patient is not motivated enough to make the necessary lifestyle changes. In short, they treat diabetes quite lightly.

Diabetes - related emotional distress


People with diabetes often experience emotional distress while living with diabetes and the effect of its complications. Many are afraid of living with diabetes and might get depressed at the thought of it. The cost of treatment is also a source of worry. Most often they worry about the future and the possibility of diabetic complications. They are constantly concerned about food and eating and feel deprived when they cannot eat what others can. They are also concerned if changes in their moods/feelings were related to diabetes.

A short tool, the PAID (Problem Areas in Diabetes ) Scale, (Psychosocial issues and Type 2 Diabetes – Gary W Welch, Katie Weinger and Alan M Jacobson), can be used to check high emotional distress related to life with diabetes. It consists of a set of twenty questions to be answered on a 5- point scale ranging between ‘not a problem’ to ‘a serious problem’.

A score above 50 shows a high level of emotional distress. Questions which score 4 on the scale indicate areas the patient finds difficult and may be’ hot- spots’ which are causing heightened emotional stress and might need professional attention.

Good listening is good for diabetes management.


Talking to people with diabetes about how they feel , and about the practical barriers they face for good diabetic self care is very important. Good listening increases the therapeutic bond and is good for diabetes management. Giving the patient a chance to talk about how he feels about his condition; being open, supportive and non-judgmental; using open- ended questions where the patient can provide information about feelings, instead of closed questions with yes/no answers; not interrupting or sharing personal views while the patient is talking; being aware of the patient’s body language(tone of voice, facial expressions use of hands, body posture, pauses, hesitations during difficult moments); maintaining good eye contact; using small encouraging body signals- nods, yes/no/ummm… are of great value to both physician and patient.

Briefly summarizing what you have heard, and checking with the patient whether what you heard is accurate at the end of the conversation is also essential.

A patient will feel less stressed once he has expressed his fears and hopes and will be motivated to make the necessary behavioural changes.

The greatest challenge in tackling T2DM is to focus on social and cultural changes and reverse the current trend through sensible, preventive strategies.

To control this growing problem , we need to prevent obesity as early in life as is possible , and this can only be done through a strong interaction between policy makers, medical fraternity and the individual.

Reference:
Gary W Welch; Katie Weinger; and Alan M Jacobson. "Psychosocial issues and Type 2 Diabetes." In Textbook of Type 2 Diabetes, Edited by Barry J Goldstein and Dirk Muller-Weiland. London, Martin Dunitz : 65-76; 2003.