• 1

    American Diabetes Association: Consensus Development Conference on Diabetic Foot Wound Care. .Diabetes Care 8::1354. ,1999. .

  • 2

    Duckworth T, Boulton AJ, Betts RP, et al: Plantar pressure measurements and the prevention of ulceration in the diabetic foot. .J Bone Joint Surg Br 67::79. ,1985. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Boulton AJ, Betts RP, Franks CI, et al: Abnormalities of foot pressure in early diabetic neuropathy. .Diabet Med 4::225. ,1987. .

  • 4

    Boulton AJ, Betts RP, Newrick PG, et al: Foot pressure abnormalities: a sensitive marker of early sensory neuropathy. .Diabetes 12 (suppl 1)::35. ,1986. .

  • 5

    Armstrong DG, Lavery LA: Plantar pressures are higher in diabetic patients following partial foot amputation. .Ostomy Wound Manage 44::30. ,1998. .

  • 6

    Armstrong DG, Peters EJ, Athanasiou KA, et al: Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration. ?J Foot Ankle Surg 37::303. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Cavanagh PR, Ulbrecht JS, Caputo GM: Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention. .Diabet Med 13 (suppl 1)::S17. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Armstrong DG, Lavery LA, Vela SA, et al: Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. .Arch Intern Med 158::289. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Lavery LA, Armstrong DG, Vela SA, et al: Practical criteria for screening patients at high risk for diabetic foot ulceration. .Arch Intern Med 158::157. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Armstrong DG, Lavery LA, Harkless LB: Who is at risk for diabetic foot ulceration. ?Clin Podiatr Med Surg 15::11. ,1998. .

  • 11

    Armstrong DG, Boulton AJM: Activity monitors: should we begin dosing activity as we dose a drug. ?JAPMA 91::152. ,2001. .

  • 12

    Schmalzried TP, Szuszczewicz ES, Northfield MR, et al: Quantitative assessment of walking activity after total hip or knee replacement. .J Bone Joint Surg Am 80::54. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Sieminski DJ, Gardner AW: The relationship between free-living daily physical activity and the severity of peripheral arterial occlusive disease. .Vasc Med 2::286. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Seedhom BB, Wallbridge NC: Walking activities and wear of prostheses. .Ann Rheum Dis 44::838. ,1985. .

  • 15

    Yamanouchi K, Shinozaki T, Chikada K, et al: Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body weight but also to improve insulin sensitivity. .Diabetes Care 18::75. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Barchfeld T, Schonhofer B, Jones P, et al: Evaluation of daily activity in patients with COPD. .Med Klin 94::93. ,1999. .

  • 17

    Bassett DR Jr, Ainsworth BE, Leggett SR, et al: Accuracy of five electronic pedometers for measuring distance walked. .Med Sci Sports Exerc 28::1071. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Meijer GA, Westerterp KR, Verhoeven FM, et al: Methods to assess physical activity with special reference to motion sensors and accelerometers. .IEEE Trans Biomed Eng 38::221. ,1991. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Edmonds ME, Blundell MP, Morris ME, et al: Improved survival of the diabetic foot: the role of a specialized foot clinic. .Q J Med 60::763. ,1986. .

  • 20

    Lippman HI, Perrotto A, Farrar R: The neuropathic foot of the diabetic. .Bull NY Acad Med 52::1159. ,1976. .

  • 21

    Litzelman DK, Marriott DJ, Vinicor F: The role of footwear in the prevention of foot lesions in patients with NIDDM: conventional wisdom or evidence-based practice. ?Diabetes Care 20::156. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Chantelau E, Kushner T, Spraul M: How effective is cushioned therapeutic footwear in protecting diabetic feet? A clinical study. .Diabet Med 7::335. ,1990. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Uccioli L, Faglia E, Monticone G, et al: Manufactured shoes in the prevention of diabetic foot ulcers. .Diabetes Care 18::1376. ,1995. .

  • 24

    Sugarman JR, Reiber GE, Baumgardner G, et al: Use of the therapeutic footwear benefit among diabetic medicare beneficiaries in three states, 1995. .Diabetes Care 21::777. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Wooldridge J, Bergeron J, Thornton C: Preventing diabetic foot disease: lessons from the Medicare therapeutic shoe demonstration. .Am J Public Health 86::935. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Chantelau E, Haage P: An audit of cushioned diabetic footwear: relation to patient compliance. .Diabet Med 11::114. ,1994. .

  • 27

    HCFA Office of Information Systems Division of Information Distribution: National Procedure Summary File Procedure Code in Range of L3201 to L3265. Health Care Financing Administration, Baltimore, 1999..

    • PubMed
    • Export Citation
  • 28

    Ramsey SD, Newton K, Blough D, et al: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. .Diabetes Care 22::382. ,1999. .

  • 29

    Lavery LA, Vela SA, Lavery DC, et al: Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations: a comparison of treatments. .Diabetes Care 19::818. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Fleischli JG, Lavery LA, Vela SA, et al: 1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers. .JAPMA 87::466. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Baumhauer JF, Wervey R, McWilliams J, et al: A comparison study of plantar foot pressure in a standardized shoe, total contact cast, and prefabricated pneumatic walking brace. .Foot Ankle Int 18::26. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Armstrong DG, Lavery LA, Bushman TR: Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts. .J Rehabil Res Dev 35::1. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Walker SC, Helm PA, Pullium G: Chronic diabetic neuropathic foot ulcerations and total contact casting: healing effectiveness and outcome probability [abstract]. .Arch Phys Med Rehabil 66::574. ,1985. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Walker SC, Helm PA, Pullium G: Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. .Arch Phys Med Rehabil 68::217. ,1987. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Sinacore DR, Mueller MJ, Diamond JE: Diabetic plantar ulcers treated by total contact casting. .Phys Ther 67::1543. ,1987. .

  • 36

    Myerson M, Papa J, Eaton K, et al: The total-contact cast for management of neuropathic plantar ulceration of the foot. .J Bone Joint Surg Am 74::261. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Helm PA, Walker SC, Pullium G: Total contact casting in diabetic patients with neuropathic foot ulcerations. .Arch Phys Med Rehabil 65::691. ,1984. .

  • 38

    Lavery LA, Armstrong DG, Walker SC: Healing rates of diabetic foot ulcers associated with midfoot fracture due to Charcot’s arthropathy. .Diabet Med 14::46. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Lavery LA, Vela SA, Lavery DC, et al: Total contact casts: pressure reduction at ulcer sites and the effect on the contralateral foot. .Arch Phys Med Rehabil 78::1268. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Armstrong DG, Nguyen HC, Lavery LA, et al: Off-loading the diabetic foot wound: a randomized clinical trial. .Diabetes Care 24::1019. ,2001. .

Continuous Activity Monitoring in Persons at High Risk for Diabetes-Related Lower-Extremity Amputation

David G. Armstrong Director of Research and Education, Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson, AZ; Visiting Senior Lecturer of Medicine, Department of Medicine, Manchester Royal Infirmary, Manchester, UK. Mailing address:Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, 3601 S Sixth Ave, Tucson, AZ 85723.

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Patricia L. Abu-Rumman Submitted during second-year residency, Department of Surgery, Podiatry Service, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ.

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Brent P. Nixon Chief of Podiatry Service, Department of Surgery, Podiatry Service, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ.

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Andrew J.M. Boulton Professor, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK.

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This study evaluated the magnitude and location of activity of diabetic patients at high risk for foot amputation. Twenty subjects aged 64.6 ± 1.8 years with diabetes, neuropathy, deformity, or a history of lower-extremity ulceration or partial foot amputation were dispensed a continuous activity monitor and a log book to record time periods spent in and out of their homes for 1 week. The results indicate that patients took more steps per hour outside their home, but took more steps per day inside their homes. Although 85% of the patients wore their physician-approved shoes most or all of the time while they were outside their homes, only 15% continued to wear them at home. Focusing on protection of the foot during in-home ambulation may be an important factor on which to focus future multidisciplinary efforts to reduce the incidence of ulceration and amputation. The ability to continuously monitor the magnitude, duration, and time of activity ultimately may assist clinicians in dosing activity just as they dose drugs. (J Am Podiatr Med Assoc 91(9): 451-455, 2001)

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