Put your sole at ease: exercise feet

Anette Thompson, a podiatrist, tells us how to exercise feet to improve blood circulation, especially if you have diabetes.

An immense amount of recent research has reinforced the fact that exercise is essential for those who live with diabetes – at whatever stage you are – pre-diabetic; diabetic on diet + exercise only; diabetic on diet + exercise + tablets; diabetic on diet + exercise + tablets +/or insulin. This makes sense because we know that exercise helps ‘switch on’ insulin receptors in those with Type 2 diabetes, therefore is useful in lowering blood sugar levels.

There are also benefits of regular exercise of the feet, such as improved blood circulation. Blood contains oxygen, nutrients and repair cells so it’s vital that increased blood supply reaches each cell in the body, especially nerves and other structures in the feet, which are furthest away from the heart.

SA research

As part of Louise Stirk (a South African podiatrist) master’s degree, she studied the effects of an eight-week endurance exercise programme on blood sugar control and peripheral sensory neuropathy in people with Type 2 diabetes.

Her study was conducted on eight previously inactive diabetic volunteers, aged 34 to 47 years. They completed an eight-week endurance exercise intervention of moderate intensity. They started the exercise programme at the same time as two control groups. The first control group, aged 45 and 46 years, continued with a sedentary (inactive) lifestyle and the second active control, aged 40 years, continued with a prior exercise programme.

All participants were requested to maintain their usual diet. The moderate exercise for the previously inactive group consisted of a 30-minute cycling regime, during which the heart rate fluctuated between 60-80% of age-predicted maximum, repeated three times per week.

She measured the effects of this endurance exercise programme on diabetic peripheral neuropathy (DPN) and possible associations between exercise-induced changes in resting heart rate, blood pressure, body mass index, waist circumference, % body fat, six objective neurological measures of diabetic peripheral neuropathy, and eight subjective ratings of symptoms of foot discomfort. She also measured changes in HbA1c, plasma brain neurotrophic factor and serum adiponectin concentrations in all 11 participants.

The only significant change (p>0.05) in the passive (non-exercising) controls was an increase in subjective ratings of foot discomfort, while no significant change (p>0.05) was observed in the active control.

The eight-week endurance exercise programme was not combined with dietary intervention so it did not improve HbA1c levels, but it did result in significant improvements (p<0.05) in the average resting heart rate, systolic blood pressure, and patellar and ankle reflexes in the group of eight people.

Common reasons for not exercising

The most common reasons as to why diabetic patients don’t exercise on a regular basis is: their feet or legs hurt, they don’t know what shoes to wear, they don’t know how to exercise, they feel it isn’t safe to walk outside or they can’t afford a gym membership.

1. Feet or legs hurt
You may have an imbalance of the feet due to the effects of diabetes on soft tissue, or because of incorrect footwear or other biomechanical reasons of which you may be unaware. Feet should never hurt – this is a sign that something is amiss.

A podiatrist will conduct a full clinical biomechanical examination or you may choose to go to a biokineticist for a full-body assessment if other parts of your body also hurt when you exercise. Take your exercise shoes as well as your usual shoes with you to be assessed.

If imbalances or bony protrusions are present in the feet or ankles, a podiatrist will then take an impression of your feet in plaster of Paris or orthopaedic foam to fabricate custom foot orthoses, which fit into your shoes.

These can re-align your feet to make muscles work in balance with each other, offload sore spots or high pressure areas, and make you comfortable in your shoes once more.

Custom inserts, made by a podiatrist, can be moved between pairs of shoes and, even sandals, with a piece of adhesive Velcro affixed underneath to prevent sliding.

Do custom shoe inserts really work

In July 2005, James Wrobel, Adam Fleischer, Ryan Crews, et al., reported in the Journal of the American Podiatric Medical Association on examining the outcomes of custom foot orthoses on patients with plantar heel pain.

These researchers randomised 77 patients with plantar fasciitis to one of three groups in a double-blind fashion (custom foot orthoses, prefabricated orthoses, and a sham). Using objective and subjective outcome measures, they found a 5,6-fold increase in physical activity and improved outcome measures with the custom foot orthoses in comparison with the other methods at three months.

2. How to exercise feet

The second largest pump mechanism of blood in the body (after the heart) is that of the calf muscle ‘pump’. When the calf muscles contract, they push up against the big blood vessels deep in the leg.

exercise feetAny exercise that helps the calf muscles to contract is a good exercise for lower limb blood circulation. Walking is excellent – choose a flexible pair of shoes that grip the back of your heels, and grip over the top of your foot with adjustable fastening.

If you have never exercised, start with a 5-minute walk then turn around and go back and you’ll have completed 10 minutes. The next day, increase by 5 minutes. The day after, increase by 5 minutes, or stay at the same number of minutes for a few days until you feel you can add on more minutes.

Motivating tip: If you are new to exercising, do not measure distance when walking as it will only discourage you, only measure by time spent. As you become fitter, you’ll naturally increase your distances. Work up to 30 minutes of exercise every second day, then eventually 30 minutes every day.

3. What shoes to wear

You need flexible flat soled shoes/takkies that have a good grip on your feet, either in the form of: laces up the foot or sturdy Velcro straps up the foot. No open back shoes. If you want to walk in hiking sandals, wear a pair of socks together with the hiking sandals to prevent chafing or blisters. Other types of fashion sandals are not suitable.

Make sure the shoes are wide enough for your feet. The easy way to check this, is to remove the innersole from the takkie and stand on top of it as if your foot was in the shoe. If your foot width spills over the sides, the shoe is too narrow for you and should be avoided.

New Balance and Asics now have sports shoes available in wider fittings, called 2E and 4E.

Be aware that your foot volume naturally increases by 7% after four hours of standing or walking, so allow for foot expansion when fitting.

exercise feetMake sure the shoe is flexible – you should be able to bend it back from the ball of the foot with one finger. If it is not flexible enough, the calf muscles can’t work to their full capacity because the foot can’t bend easily at the ball of the foot.

4. Can’t afford gym or scared to walk outside?

Here are simple ways to exercise feet in your own home:

Sitting: Sit up on a chair with your feet flat on ground and knees bent to 90 degrees. Keeping your toes on the ground, lift the heels off the ground then put them down. Increase the number of repetitions until the calf muscles feel tired, then stop.

The next day, try to increase beyond the previous day’s number of repetitions by 1, the day after by 2, the day after that by 3. That way you will gradually build up to being able to do 300 repetitions while watching TV, or sitting in the office, or waiting at an appointment.

Standing: You can do calf raises holding onto the back of a chair, or the supermarket trolley, or while waiting for the kettle to boil or the photocopy machine to do its work.

On your bed: If the weather isn’t good, you can still lie on your bed and do exercises pointing your toes away from you and then pointing them towards you. Do at least 100 repetitions or until your calf muscles ache. If you persist with the exercise each day, it will become easier to do and the aches ease up as you improve your blood circulation.

MEET OUR EXPERT - Anette Thompson

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.

How to exercise at the office

Paula Pienaar explains the benefits of exercise for diabetic patients, and shares five easy workouts to do at the office.

An abundance of research has shown that a regular dose of physical activity reaps significant benefits to individuals with high blood glucose levels1. In pre-diabetics, moderate intensity activity has shown to delay the onset of diabetes and may even restore higher blood sugar levels back to the healthy range.

In diabetic patients, regular physical activity has shown to improve blood sugar control, reduce the number of cardiovascular risk factors (high blood pressure, high cholesterol, excess body fat) and use of chronic medication2,3.  Evidently, being a physically active diabetic patient may lower your risk of heart disease by 29% and risk of mortality by 40% compared to those who are inactive4. However, for all these benefits to be effective, exercise must be undertaken regularly.

Benefits of regular physical activity in diabetic patients:

  • Improved blood sugar control.
  • Increased fitness.
  • Improved blood pressure.
  • Improved lipid profile (cholesterol and triglyceride levels).
  • Reduced abdominal and body fat levels.
  • Maintenance of weight loss.
  • Improved mobility in overweight and obese diabetic patients.
  • Decreased stress and anxiety, and an improvement in overall well-being.

Physical activity recommendations for diabetic patients:

Type of activity How long and how often? How hard? Examples Tips

[rhythmic, repetitive and continuous movement of the same large muscle groups for at least 10 minutes at a time]

Accumulated 150 minutes per week or 30 minutes on most days of the week. Moderate intensity: this means working up a light sweat but still being able to maintain a conversation. If you are a ‘numbers person’, aim for 50% – 70% of your maximum heart rate (MHR).
  • Brisk walking
  • Dancing
  • Cycling
  • Swimming
  • Gardening and housework that raises your heart rate.
MHR = 220 – (your age)

Example: The MHR of a 40-year-old is 180 beats per minute (220 minus 40 years) and 50% to 70% MHR = 90 to 126 beats per minute.

Strength/resistance training

[activities of brief duration involving the use of weights, weight machines or resistance bands to increase muscle strength and endurance]

Two to three times a week consisting of 2 to 3 sets of 10 – 15 repetitions (reps)
  • Start with one set using a weight which you can perform 15-20 reps while maintaining proper form.
  • Progress to two sets and decrease the number of reps to 10-15 while increasing the weight slightly.
  • Use of free weights (dumbbells).
  • Use of your own body weight (no equipment).
  • Use of a resistance band.
See the office-based exercises for some inspiration.

IMPORTANT: first get clearance from your medical doctor before starting with an exercise plan. A biokineticist is ideal to design a personalized exercise programme to suit your needs, personal goals and lifestyle.

Exercise at the workplace

Meeting the guidelines may seem like a challenge, but you can incorporate simple, yet effective exercises throughout the day – all you need is your own body weight.

For cardiovascular exercise, you could set aside three sessions of 10 minutes, or two of 15 minutes to go out for a brisk walk or light jog – grab a colleague if you must, the more the merrier! In addition to the physical benefits you gain, studies have shown that active breaks from the office may also help improve mental performance and work productivity. Meeting the strength training guideline can be accomplished by incorporating the exercises below.

5 easy exercises you can do in your office

Perform 2 to 3 sets of 10 to 15 repetitions

Exercise Instructions Adjusting intensity

You can lower the amount of repetitions or sets. But can also try the following:

Chair squats

  • Using a steady chair, start from a seated position and extend or cross your arms in front of you.
  • Exhale as you lift yourself slowly, hovering for 2-3 seconds, then stand all the way up.
  • Sit back down slowly and repeat.
  • Too easy? Bring your arms to your chest, or hold books or a file to add resistance to the move.
  • Too hard? Increase the height of your sitting surface.
Calf raises

An easy exercise for when you’re waiting for the printer, the kettle or the microwave!

  • Stand up straight, feet shoulder width apart.
  • Keeping your knees straight, rise onto your toes, hold for 2 seconds and lower your heels to the ground and repeat.
  • Too easy? Try the exercise on one leg, or using the stairs, stand with your heels off the step to do the calf raises.
Desk push-ups 
  • Take a large step away from your desk, feet and hands shoulder width apart.
  • Bend your elbows as you move your chest toward the desk.
  • Hold for 2 seconds and return to starting position.
  • Keep your back straight and abdominals drawn in throughout the movement.
  • Adjust your arm width to make it easier or more difficult.
  • Too hard? Start by using the wall instead of the desk.
Chair dips


  • Bring your hands to the front edge of a steady chair with the hands shoulder-width apart and finger tips extended over the edge of the seat.
  • Relax your shoulders and neck, and bend your knees to a 90 degree angle.
  • While inhaling, bend your elbows bringing your buttocks towards the floor.
  • Your back should stay straight and feet hip-width apart, in line with your hips.
  • Exhale slowly as you straighten your arms to return to starting position.
  • Too easy? Move your feet further away from you.
  • The spacing between your feet and your buttocks can help you adjust the amount of weight you are putting on your arms.
Chair abs: knee pull-ups

  • Place your hands at your side, on the edge of a steady chair and keep your elbows straight
  • Grip the chair holding firmly
  • While gripping, inhale, and slowly exhale as you bring your knees up toward your chest
  • Hold for 5 seconds
  • Inhale again, and exhale as you lower back to starting position with a slow and controlled motion (± 10 seconds)
  • To make it a bit harder, perform the movement at a slower pace, making sure you maintain the breathing rate and keeping your abdominals tight.

Take note: Individuals who wish to begin resistance exercises should receive initial instruction and periodic supervision by a qualified exercise specialist like a biokineticist where possible, to maximise benefits while minimising risk of injury. Do not hold your breath during exercises – follow the guidelines in the description.


  1. Colberg, Sheri R., et al. “Physical activity/exercise and diabetes: a position statement of the American Diabetes Association.” Diabetes Care 39.11 (2016): 2065-2079.Hu G, Jousilahti P, Barengo NC, et al. Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care. 2005; 28:799-805.
  2. Gill, Jason MR, and Dalia Malkova. “Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity.” Clinical science 110.4 (2006): 409-425.
  3. Way, Kimberley L., et al. “The effect of regular exercise on insulin sensitivity in type 2 diabetes mellitus: a systematic review and meta-analysis.” Diabetes & metabolism journal 40.4 (2016): 253-271.
  4. Kodama, Satoru, et al. “Association between physical activity and risk of all-cause mortality and cardiovascular disease in patients with diabetes.” Diabetes care 36.2 (2013): 471-479.


MEET OUR EXPERT - Paula R. Pienaar

Paula R. Pienaar
Paula R. Pienaar (BSc (Med)(Hons) Exercise Science (Biokinetics)), MSc (Med) Exercise Science) is the scientific advisor to EOH Workplace Health and Wellness, and a PhD candidate at the University of Cape Town. Her scientific research relates to sleep health and managing daytime fatigue to improve workplace productivity and lower the risk of chronic disease. Her thesis will identify the link between sleep and cardiometabolic diseases (Type 2 diabetes and cardiovascular disease) in South African employees. She aims to design a tailored sleep and fatigue management workplace health intervention to improve employee health risk profiles and enhance work productivity. Contact her at [email protected]