The effect of massage on improving blood circulation in diabetic feet

============================================== Diabetes is one of the most common chronic diseases in the world today, which if not managed properly, can cause many complications for the body; One of the most important of them is foot problems. From the loss of sensation in the lower limbs to the occurrence of persistent ulcers and even the risk of amputation, all are common consequences of diabetes. In the meantime, careful and preventive care of the feet plays a vital role in preventing these complications. One of the effective and relatively simple methods that can help patients in this field is "massage therapy". Massage, beyond creating a sense of relaxation, helps to improve blood circulation, skin flexibility, reduce dryness and increase cell nutrition. In this article, we will fully review the role of massage in the prevention of diabetic foot ulcers and explain how this low-cost and accessible method can become one of the most important care tools for diabetic patients. blood circulation problems in diabetic patients Diabetes, especially if left uncontrolled, can have significant effects on the body's circulatory system. One of the organs most affected by this metabolic disorder is the legs; Because they are considered the most extreme part of the body and it is challenging to supply them with proper blood even under normal conditions, let alone when diabetes has destroyed the walls of blood vessels. ### Why does diabetes reduce blood flow in the organs? In type 1 or type 2 diabetes, blood vessels are damaged due to continuous high blood sugar. High sugar causes an increase in inflammatory substances in the blood and over time destroys the inner wall of blood vessels, especially fine veins and capillaries. This process thickens the vessel wall, reduces its elasticity and narrows the blood flow path. On the other hand, diabetes also affects the nervous system and causes damage to the autonomic nerves that control the contraction and expansion of blood vessels. As a result, the leg veins lose the ability to properly respond to the body's needs to increase or decrease blood flow. Also, many diabetic patients suffer from hardening of the arteries or atherosclerosis (hardening and blockage of the arteries), which again prevents oxygen-rich blood from reaching the tissues of the lower body, including the legs. This condition is especially aggravated in the elderly or those who smoke or are less active. ### Effects of diabetic neuropathy on leg vessels: Diabetic neuropathy is one of the most common long-term complications of diabetes that affects more than half of diabetic patients. This condition targets the peripheral nerves and usually occurs in the lower limbs such as the legs in the form of numbness, tingling, burning or chronic pain. The important thing is that nerves play an important role in regulating the diameter of blood vessels and controlling blood flow. When these nerves are damaged, the vessels cannot open and close properly to regulate the blood flow according to the needs of the tissues. As a result, the blood supply to the skin, muscles and other tissues of the foot decreases. On the other hand, patients may not feel minor injuries such as scrapes, shoe pressure or cuts due to loss of sensation in their feet. In the absence of proper blood flow, these injuries easily turn into chronic wounds that are difficult to heal and sometimes even lead to amputation. Why is massage useful for diabetic feet? Massage therapy is one of the complementary and non-invasive methods to improve the quality of life of diabetic patients, especially in the field of foot care. While nutrition, medicine and exercise are the three main pillars of diabetes management, massage can play a very effective role in reducing the complications of diabetes in the lower limbs by directly affecting blood circulation, lymphatic system, muscles and nerves. Many physical medicine specialists, wound nurses, and physical therapists recommend gentle foot massage as part of daily care for diabetic patients. ### Capillary blood flow stimulation: The first and perhaps the most important effect of massage in diabetics is to increase blood circulation in areas that have decreased blood flow; Especially the legs. As mentioned in the previous section, high blood sugar levels cause narrowing or blockage of blood vessels, especially the fine capillaries in the legs. This reduction in blood supply is the basis of many problems such as delayed healing of wounds, dry skin, numbness and increased risk of diabetic ulcers. Massage causes physical stimulation of the skin surface and underlying tissues. This stimulation leads to an increase in local temperature, which in itself causes the blood vessels to dilate and increase the blood flow in the desired area. This phenomenon is known as "hyperemia" and it means that the tissues receive more blood. By increasing the blood flow in the capillaries, oxygen and vital nutrients reach the cells of the skin, muscles and nerves more effectively, and metabolic wastes are also eliminated better. This issue becomes more important especially in diabetic patients who suffer from chronic fatigue, dry feet and reduced touch sensitivity. Even a gentle daily massage of a few minutes can have significant effects in improving blood flow and prevent the occurrence or exacerbation of complications. ### Increasing oxygen supply and tissue nutrition: When the blood flow in the legs is improved, the tissues of the body not only receive more blood, but also the quality of this blood supply. In simpler terms, blood carries oxygen and nutrients needed by cells. When the massage improves the local blood flow, the oxygen supply to the skin, muscles and peripheral nerves is better, and as a result, the process of regeneration, repair and cell function is improved. For diabetics, this is critical, as the skin cells on the feet are often on the verge of damage due to chronic lack of oxygen. This condition, along with dryness and reduced sense of touch, provides ideal conditions for the formation of skin cracks and open wounds. On the other hand, improving cellular nutrition with regular massage can help rebuild damaged structures, increase collagen production, and maintain skin elasticity. As a result, the foot skin is less exposed to tearing, infection and environmental damage. Also, leg and foot muscles, which may become weak or atrophy due to inactivity or neuropathy, benefit from better oxygenation and maintain their strength. ### Reducing swelling and fluid retention in the legs: Another important benefit of foot massage in diabetic patients is the reduction of swelling or edema. Many people with diabetes develop fluid retention in the legs, especially if they also have kidney problems or high blood pressure. This swelling is often caused by a disturbance in the return of blood and lymph fluid from the legs to the heart. Massage, especially lymphatic drainage massage, can help lymph flow better and reduce chronic swelling. This type of massage, with soft and directional movements, helps drain accumulated fluids in soft tissues and reduces the feeling of heaviness, pain, and pressure in the legs. In addition, reducing swelling helps improve cellular respiration and reduces the risk of excessive pressure on the skin. Swollen skin is much more fragile and more prone to cracking or scarring. With regular and principled massage, patients can not only get rid of pain and discomfort caused by swelling, but also prevent more serious problems. Effect of massage in reducing symptoms of diabetic neuropathy Diabetic neuropathy or damage to peripheral nerves due to continuous high blood sugar is one of the most common complications in patients with diabetes. This disorder manifests itself especially in the extremities such as the legs and is associated with symptoms such as chronic pain, burning, tingling, numbness and sometimes electric shock. Unfortunately, these symptoms not only disrupt the patient's daily life, but also increase the risk of skin damage, non-healing wounds, and ultimately dangerous infections. ### Effect of massage in reducing pain, tingling and numbness: One of the proven uses of massage therapy is to reduce pain and discomfort in neuropathic patients. Pain from diabetic neuropathy is usually felt continuously or intermittently and is often worse at night. By stimulating touch receptors in the skin and soft tissues, massage can weaken pain signals in the nervous system. This phenomenon is known as "Gate Control Theory of Pain". According to this theory, when touch or gentle pressure caused by massage is applied to the peripheral nerves, positive signals reach the spinal cord and the nerve pathways that transmit pain information to the brain are temporarily blocked. As a result, the intensity of pain decreases or even stops for a while. On the other hand, massage improves blood flow in the affected areas. This increase in blood supply can improve nerve nutrition and help in the partial repair of damaged nerve fibers. As a result, the feeling of numbness is reduced and the tingling or discomfort in the legs is improved. ### Investigation of the nervous system relaxation mechanism: Massage not only affects the tissues and nerves physically, but it also has neuro-hormonal calming effects. When a person undergoes a massage, the body begins to release hormones such as serotonin and endorphins. These natural chemicals play an effective role in improving mood, reducing stress and inhibiting pain transmitters. In diabetic patients, chronic stress can aggravate neuropathy symptoms. Stress causes increased blood sugar, sleep disturbance and greater sensitivity to pain. By activating the parasympathetic system (the body's relaxing system), regular massage can reduce heart rate, lower blood pressure, and provide a calming environment for the nervous system. Also, massage can help restore the balance between the sympathetic nervous system (which activates the fight and flight responses) and the parasympathetic. This balance plays an important role in controlling nerve inflammation, reducing muscle spasm, improving sleep and generally reducing nerve discomfort in diabetic patients. ### Patients' experience of symptom improvement after repeated massage: There are many clinical evidences and experimental reports showing that diabetic patients experienced a significant reduction in the severity of their neuropathy symptoms after receiving regular foot massage. In several studies, patients have stated that after a few weeks of massage therapy (2 to 3 times a week), their night pain decreased, leg numbness decreased, and sleep quality improved. In some cases, people who have suffered for years with "cold feet," constant tingling, or electric shocks have experienced a significant improvement in the tactile sensation of their feet after receiving regular, gentle massage. Even in patients who had lost the ability to walk for a long time, massage has been able to help the partial return of leg muscle function and reduce fatigue. Massage and prevention of diabetic foot ulcers Diabetic foot ulcer is one of the most serious and worrying complications of diabetes, which not only disrupts the daily life of the patient, but also brings a heavy psychological and financial burden. Loss of sensation in the legs, poor blood circulation and dry skin are among the key factors in the occurrence of these wounds. Correct and regular massage helps to improve skin flexibility, maintain moisture, increase cell nutrition and repair microdamages. ### Increasing flexibility of skin and soft tissue: In diabetic patients, due to decreased blood supply and nerve damage, the soft tissues of the foot, such as skin, muscles and ligaments, lose their elasticity. This causes the skin on the feet to become dry, thick, hard and brittle. Such conditions increase the possibility of cracks, tears or blisters even due to minor pressures or inappropriate shoes. Gentle foot massage increases the local temperature of the skin, stimulates blood flow and improves the function of collagen and elastin fibers in the skin. These effects help restore the natural softness and flexibility of the skin and soft tissue. Also, massaging with circular motions or gentle rubs will soften fibrotic or hardened tissues and prevent excessive dryness. Proper elasticity of the skin means reducing the possibility of cracking, stretching and scarring due to daily movements or contact with objects. As a result, regular massage can indirectly prevent skin ulcers, especially in elderly patients who have thinner skin. ### Helps to prevent dryness and cracking of the skin: Dry skin is one of the common problems in the feet of diabetic patients. Decreased sweating due to damage to the autonomic nerves, chronic body dehydration, and weak blood circulation are among the factors that make the skin of the feet prone to dryness. Dry skin without moisture cracks easily, and if these cracks become deep, they become a gateway for bacteria to enter, leading to infection and diabetic ulcers. Massage therapy using suitable vegetable oils (such as coconut oil, olive oil, sweet almond oil or shea butter) can create a protective layer on the skin and prevent water evaporation. In addition to moisturizing, these oils also have anti-inflammatory, antioxidant and antibacterial properties. Massage with oil not only helps better absorption of nutrients in the skin, but also gently removes dead and horny layers of the skin and opens the way for the skin to breathe better. This process softens the surface of the skin, increases softness and reduces the possibility of cracking and severe dryness. Therefore, massage can be considered a practical and effective way to maintain the moisture of the foot skin and prevent dangerous cracks, which can prevent serious wounds in diabetic patients. ### Effect of massage in improving cell nutrition and wound healing: One of the prominent features of massage is improving cell nutrition and accelerating the tissue regeneration process. When the feet are massaged, the blood supply in the superficial and deep capillaries increases and oxygen, minerals, and essential vitamins reach the cells more quickly. This fresh blood also helps to clear metabolic waste from the cells and provides a suitable environment for the repair and regeneration of damaged cells. Such nutrition is especially critical in areas where wound healing is delayed due to nerve damage and poor circulation. In addition, massage can help stimulate the growth of new capillaries around small, latent wounds. This process, which is called "angiogenesis", ultimately helps to increase the regenerative capacity of the skin and tissue and accelerates the healing process. Another important point is that massage can be used as a preventive and strengthening method for the skin in cases where there is no superficial wound or minor injury. In fact, by strengthening the different layers of the skin and improving the ability of cells to regenerate, future scars are prevented. ### Massage therapy, a vital bridge to maintain the health of diabetic feet In the end, we can say that massage therapy is not only a complementary method to improve the condition of diabetic feet, but also acts as a bridge between physical care and metabolic health. Its effect on improving blood circulation, reducing neuropathy symptoms, increasing skin flexibility and even preventing chronic wounds has made this method one of the valuable tools in the management of diabetes. With the principled and regular implementation of massage, the quality of life of diabetic patients can be significantly improved and the risk of serious foot complications can be reduced. Massage is not only physical relaxation, but also assurance for a healthier future on the way to controlling diabetes. Important points you should not forget about foot massage: - Before the massage, the nerve and blood vessels of the legs must have been examined by your doctor and there are no wounds or cracks (in this case, you can ask Dr. Yazdan Panah to do these examinations for you) - Quality and frequency of massage is important. - The amount of massage pressure is very important. - The type of massage and the mental state of the patient should be considered. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**