advertising
-
1.
Armstrong DG , Boulton AJM & Bus SA: Diabetic foot ulcers and their recurrence. N Engl J Med 376: 2367, 2017.
-
2.
Jeffcoate WJ , Vileikyte L & Boyko EJ et al.: Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes Care 41: 645, 2018.
-
3.
Lazzarini PA , Pacella RE & Armstrong DG et al.: Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med 35: 1297, 2018.
-
4.
Boulton AJM , Kirsner RS & Vileikyte L: Neuropathic diabetic foot ulcers. N Engl J Med 351: 48, 2004.
-
5.
Boulton AJM: The diabetic foot: from art to science: the 18th Camillo Golgi lecture. Diabetologia 47: 1343, 2004.
-
6.
Singh N , Armstrong DG & Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA 293: 217, 2005.
-
7.
Ribu L , Birkeland K & Hanestad BR et al.: A longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: wound healing and quality-of-life changes. J Diabetes Complications 22: 400, 2008.
-
8.
Johnson NA , Barwick AL & Searle A et al.: Self-reported physical activity in community-dwelling adults with diabetes and its association with diabetes complications. J Diabetes Complications 33: 33, 2019.
-
9.
Kang GE & Najafi B: Sensor-based daily physical activity: towards prediction of the level of concern about falling in peripheral neuropathy. Sensors 20: 505, 2020.
-
10.
Sheahan H , Canning K & Refausse N et al.: Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free-living environments. Int Wound J 14: 1175, 2017.
-
11.
Colberg SR , Sigal RJ & Yardley JE et al.: Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39: 2065, 2016.
-
12.
Schaper NC , Netten JJ & Apelqvist J et al.: Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev 36 (suppl 1): e3266, 2020.
-
13.
van Netten JJ , van Baal JG & Liu C et al.: Infrared thermal imaging for automated detection of diabetic foot complications. J Diabetes Sci Technol 7: 1122, 2013.
-
14.
Alahakoon C , Fernando M & Galappaththy C et al.: Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 37: 1266, 2020.
-
15.
Armstrong DG , Holtz-Neiderer K & Wendel C et al.: Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med 120: 1042, 2007.
-
16.
Lavery LA , Higgins KR & Lanctot DR et al.: Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care 27: 2642, 2004.
-
17.
Wrobel JS , Ammanath P & Le T et al.: A novel shear reduction insole effect on the thermal response to walking stress, balance, and gait. J Diabetes Sci Technol 8: 1151, 2014.
-
18.
Rahemi H , Armstrong DG & Enriquez A et al.: Lace up for healthy feet: the impact of shoe closure on plantar stress response. J Diabetes Sci Technol 11: 678, 2017.
-
19.
Najafi B , Grewal GS & Bharara M et al.: Can't stand the pressure: the association between unprotected standing, walking, and wound healing in people with diabetes. J Diabetes Sci Technol 11: 657, 2017.
-
20.
Grewal GS , Schwenk M & Lee-Eng J et al.: Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in diabetics with peripheral neuropathy: a randomized controlled trial. Gerontology 61: 567, 2015.
-
21.
Fernando ME , Crowther RG & Lazzarini PA et al.: Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration. BMC Endocr Disord 16: 51, 2016.
-
22.
Fernando ME , Crowther RG & Cunningham M et al.: Lower limb biomechanical characteristics of patients with neuropathic diabetic foot ulcers: the diabetes foot ulcer study protocol. BMC Endocr Disord 15: 59, 2015.
-
23.
Najafi B , Crews RT & Wrobel JS: Importance of time spent standing for those at risk of diabetic foot ulceration. Diabetes Care 33: 2448, 2010.
-
24.
Fernando ME , Crowther RG & Lazzarini PA et al.: Gait in people with nonhealing diabetes-related plantar ulcers. Phys Ther 99: 1602, 2019.
-
25.
Ling E , Lepow B & Zhou H et al.: The impact of diabetic foot ulcers and unilateral offloading footwear on gait in people with diabetes. Clin Biomech 73: 157, 2020.
-
26.
Studenski S , Perera S & Patel K: Gait speed and survival in older adults. JAMA 305: 50, 2011.
-
27.
Bruce DG , Davis WA & Davis TME: Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 28: 2441, 2005.
-
28.
Venkataraman K , Tai BC & Khoo EYH et al.: Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial. Diabetologia 62: 2200, 2019.
-
29.
Lemaster JW , Mueller MJ & Reiber GE et al.: Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial. Phys Ther 88: 1385, 2008.
-
30.
Mueller MJ , Tuttle LJ & Lemaster JW et al.: Weight-bearing versus nonweight-bearing exercise for persons with diabetes and peripheral neuropathy: a randomized controlled trial. Arch Phys Med Rehabil 94: 829, 2013.
-
31.
Kluding PM , Bareiss SK & Hastings M et al.: Physical training and activity in people with diabetic peripheral neuropathy: paradigm shift. Phys Ther 97: 31, 2017.
-
32.
Lazzarini PA , Crews RT & van Netten JJ et al.: Measuring plantar tissue stress in people with diabetic peripheral neuropathy: a critical concept in diabetic foot management. J Diabetes Sci Technol 13: 869, 2019.
-
33.
Matos M , Mendes R & Silva AB et al.: Physical activity and exercise on diabetic foot related outcomes: a systematic review. Diabetes Res Clin Pract 139: 8190, 2018.
-
34.
Zwanenburg PR , Backer SFM & Obdeijn MC et al.: A systematic review and meta-analysis of the pressure-induced vasodilation phenomenon and its role in the pathophysiology of ulcers. Plast Reconstr Surg 144: 669e, 2019.
-
35.
Lemaster JW , Reiber GE & Smith DG et al.: Daily weight-bearing activity does not increase the risk of diabetic foot ulcers. Med Sci Sports Exerc 35: 1093, 2003.
-
36.
Maluf KS & Mueller MJ: Comparison of physical activity and cumulative plantar tissue stress among subjects with and without diabetes mellitus and a history of recurrent plantar ulcers. Clin Biomech 18: 567, 2003.
-
37.
Najafi B , Reeves ND & Armstrong DG: Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer-free days in remission. Diabetes Metab Res Rev 36 (suppl 1): e3239, 2020.
-
38.
Armstrong DG , Lavery LA & Holtz-Neiderer K et al.: Variability in activity may precede diabetic foot ulceration. Diabetes Care 27: 1980, 2004.
-
39.
Waaijman R , de Haart M & Arts MLJ et al.: Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients. Diabetes Care 37: 1697, 2014.
-
40.
Crews RT , Schneider KL & Yalla SV et al.: Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes Metab Res Rev 32: 791, 2016.
-
41.
Lazzarini PA , Jarl G & Gooday C et al.: Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review. Diabetes Metab Res Rev 36 (suppl 1): e3275, 2020.
-
42.
Bus SA , Lavery LA & Monteiro-Soares M et al.: Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36 (suppl 1): e3269, 2020.
-
43.
Vileikyte L , Crews RT & Reeves ND: Psychological and biomechanical aspects of patient adaptation to diabetic neuropathy and foot ulceration. Curr Diab Rep 17: 109, 2017.
-
44.
Ahmed S , Barwick A & Butterworth P et al.: Footwear and insole design features that reduce neuropathic plantar forefoot ulcer risk in people with diabetes: a systematic literature review. J Foot Ankle Res 13: 30, 2020.
-
45.
Petersen BJ , Rothenberg GM & Lakhani PJ et al.: Ulcer metastasis? anatomical locations of recurrence for patients in diabetic foot remission. J Foot Ankle Res 13: 1, 2020.
-
46.
Basatneh R , Najafi B & Armstrong DG: Health sensors, smart home devices, and the internet of medical things: an opportunity for dramatic improvement in care for the lower extremity complications of diabetes. J Diabetes Sci Technol 12: 577, 2018.
-
47.
Abbott CA , Chatwin KE & Foden P et al.: Innovative intelligent insole system reduces diabetic foot ulcer recurrence at plantar sites: a prospective, randomised, proof-of-concept study. Lancet Digit Health 1: e308, 2019.
-
48.
Bus SA: Innovations in plantar pressure and foot temperature measurements in diabetes. Diabetes Metab Res Rev 32 (suppl 1): 221, 2016.
-
49.
Golledge J , Fernando M & Lazzarini P et al.: The potential role of sensors, wearables and telehealth in the remote management of diabetes-related foot disease. Sensors 20: 4527, 2020.
-
50.
Searle A , Spink MJ & Oldmeadow C et al.: Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: a randomised controlled trial. Clin Biomech 69: 52, 2019.
-
51.
Liao F , An R & Pu F et al.: Effect of exercise on risk factors of diabetic foot ulcers: a systematic review and meta-analysis. Am J Phys Med Rehabil 98: 103, 2019.
-
52.
Allen MD , Doherty TJ & Rice CL et al.: Physiology in medicine: neuromuscular consequences of diabetic neuropathy. J Appl Physiol 121: 1, 2016.
-
53.
Sumpio BE , Armstrong DG & Lavery LA et al.; Society for Vascular Surgery, American Podiatric Medical Association: The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. JAPMA 100: 309, 2010.
-
54.
Khan T , Plotkin A & Magee GA et al.: Functional ambulatory status as a potential adjunctive decision-making tool following wound, level of ischemia, and severity of foot infection assessment. J Vasc Surg 72: 738, 2020.
-
55.
Do you prescribe thermometry for your diabetic foot patients? here's a printable daily diary for them. Available at: https://diabeticfootonline.com/2015/09/09/do-you-prescribe-thermometry-for-your-diabetic-foot-patients-heres-a-printable-daily-diary-for-them/. Accessed July 10, 2020.
-
56.
Fuchs D , Dupon PP & Schaap LA et al.: The association between diabetes and dermal microvascular dysfunction non-invasively assessed by laser Doppler with local thermal hyperemia: a systematic review with meta-analysis. Cardiovasc Diabetol 16: 11, 2017.
-
57.
Barwick AL , Tessier JW & Janse de Jonge X et al.: Peripheral sensory neuropathy is associated with altered postocclusive reactive hyperemia in the diabetic foot. BMJ Open Diabetes Res Care 4: e000235, 2016.
Dosing Activity and Return to Preulcer Function in Diabetes-Related Foot Ulcer Remission
Patient Recommendations and Guidance from the Limb Preservation Consortium at USC and the Rancho Los Amigos National Rehabilitation Center
Search for other papers by Malindu E. Fernando in
Current site
Google Scholar
PubMed
Search for other papers by Stephanie L. Woelfel in
Current site
Google Scholar
PubMed
Search for other papers by Diana Perry in
Current site
Google Scholar
PubMed
Search for other papers by Bijan Najafi in
Current site
Google Scholar
PubMed
Search for other papers by Tanzim Khan in
Current site
Google Scholar
PubMed
Search for other papers by Charles DuBourdieu in
Current site
Google Scholar
PubMed
Search for other papers by Laura Shin in
Current site
Google Scholar
PubMed
Search for other papers by David G. Armstrong in
Current site
Google Scholar
PubMed
Diabetes-related foot ulcers are a leading cause of global morbidity, mortality, and health-care costs. People with a history of foot ulcers have a diminished quality of life attributed to limited walking and mobility. One of the largest concerns is ulceration recurrence. Approximately 40% of patients with ulcerations will have a recurrent ulcer in the year after healing, and most occur in the first 3 months after wound healing. Hence, this period after ulceration is called “remission” due to this risk of reulceration. Promoting and fostering mobility is an integral part of everyday life and is important for maintaining good physical health and health-related quality of life for all people living with diabetes. In this short perspective, we provide recommendations on how to safely increase walking activity and facilitate appropriate off-loading and monitoring in people with a recently healed foot ulcer, foot reconstruction, or partial foot amputation. Interventions include monitored activity training, dosed out in steadily increasing increments and coupled with daily skin temperature monitoring, which can identify dangerous “hotspots” prone to recurrence. By understanding areas at risk, patients are empowered to maximize ulcer-free days and to enable an improved quality of life. This perspective outlines a unified strategy to treat patients in the remission period after ulceration and aims to provide clinicians with appropriate patient recommendations based on best available evidence and expert opinion to educate their patients to ensure a safe transition to footwear and return to activity.
Southwestern Academic Limb Salvage Alliance, Limb Preservation Program, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA.
Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Ulcer and Wound Healing Consortium, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA.
Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA.
Department of Prosthetics and Orthotics, Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA.
Conflict of Interest: None reported.
advertising
