Effects of a Comprehensive Physical Therapy Program on Neurological and Functional Outcomes in Patients with Neuropathic Diabetic Foot Ulcers: A Prospective Pre–Post Interventional Study

Background: Neuropathic diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, contributing significantly to morbidity and healthcare burden. Although multidisciplinary management is recommended, evidence supporting structured physical therapy interventions remains limited, particularly from prospective interventional studies. Objective: To evaluate the effects of a comprehensive physical therapy program on neurological and functional outcomes in patients with neuropathic DFUs. Methods: This prospective pre–post interventional study included 40 patients with neuropathic DFUs. Participants underwent an 8-week supervised physical therapy program (3 sessions/week) comprising therapeutic exercises, electrotherapy, gait training, off-loading strategies, and education. Outcomes included motor and sensory nerve conduction studies (common peroneal and posterior tibial nerves), ankle dorsiflexion range of motion (ROM), superficial sensation (10-g monofilament), knee extensor strength, and quality of life (EQ-5D-5L). Data were analysed using paired t-tests or Wilcoxon signed-rank tests (α = 0.05), with effect sizes (Cohen’s d) and 95% confidence intervals (CI) reported. Results: Significant improvements were observed in motor and sensory nerve conduction parameters (p < 0.001; large effect sizes, d = 0.80–1.45). Ankle dorsiflexion ROM and superficial sensation also improved significantly (p < 0.001; d > 1.0). Improvements in knee extensor strength and EQ-5D-5L scores were not statistically significant (p > 0.05). Ulcer recurrence occurred in 12.5% of participants. Conclusion: A structured physical therapy program was associated with significant improvements in neurological and functional outcomes in patients with neuropathic DFUs. However, findings should be interpreted cautiously due to the absence of a control group. Randomized controlled trials are required to establish causality.