Effects of Non-pharmacological and Complementary Interventions on Foot Function in Painful and Non-painful Diabetic Peripheral Neuropathy

Review Article

Abstract

Diabetic peripheral neuropathy (DPN) is a major determinant of diabetic foot disease and lower-limb amputation, affecting not only pain but also foot function, gait, balance, and ulcer risk. While non-pharmacological and complementary interventions are increasingly used as adjuncts to pharmacotherapy in both painful and non-painful DPN, the extent to which these approaches influence foot-related outcomes remains unclear. This review synthesises current evidence on the effects of non-pharmacological (e.g. foot–ankle exercise, physical therapy, insoles and orthoses, educational and web-based programmes) and complementary interventions (e.g. reflexology, acupuncture, Reiki, foot massage) on foot function in individuals with DPN. Across randomized and controlled trials, foot–ankle–focused exercise programmes consistently improved intrinsic foot muscle strength, plantar pressure distribution, ankle–foot kinematics, balance, and gait performance, and reduced mechanical risk factors associated with ulceration. Insoles and orthoses with various materials and designs were shown to lower peak plantar pressures and pressure–time integrals and redistribute load away from high-risk metatarsal head regions, supporting their role as effective off-loading strategies. Complementary therapies demonstrated beneficial effects on neuropathic pain and overall quality of life; however, foot function-specific outcomes (e.g. plantar pressure, deformity progression, ulcer incidence, foot-related quality of life) were rarely assessed and were typically reported only as secondary, limited endpoints. Overall, the evidence supports integrating structured exercise and podiatric off-loading strategies into DPN management, while highlighting the need for methodologically robust trials that systematically evaluate foot-centred outcomes to clarify the true podiatric impact of complementary interventions.