Abstract
Physical activity is an essential part of general health and diabetes management. However, recommending weight-bearing physical activity for people with plantar diabetic foot ulcers is controversial, even when gold standard offloading devices are used, as it is commonly thought to delay healing. We aimed to narratively review relevant studies investigating the relationship between plantar diabetic foot ulcer healing and weight-bearing activity, plantar pressure and device adherence. We defined relevant studies as those from two systematic reviews, along with those identified since using a similar updated Pubmed search strategy. We identified six studies. One study found that more daily steps were associated with worse ulcer healing, three found no significant association between steps and ulcer healing, and in two others the association was unclear. Thus, there is weak evidence for an inverse relationship between weight-bearing physical activity and plantar ulcer healing while utilizing offloading devices. We propose a Diabetic foot Offloading and Activity framework to guide future research to find the optimal balance between the positive and negative effects of weight-bearing activity in the context of foot ulcers. We hope such future studies will shed more conclusive light on the impact of weight-bearing activity on healing of plantar diabetic foot ulcers.
Highlights
Physical activity is an essential part of general health and diabetes management
Non-removable knee-high offloading devices were developed to try to meet these needs, such as the total contact cast (TCC) [25,26] and more contemporary ‘‘instant” TCC that consists of a knee-high walker rendered irremovable [27,28]
Each type of offloading device can be investigated with the help of this framework, to try to find the optimal balance between ulcer healing and side effects
Summary
Recommending weight-bearing physical activity for people with plantar diabetic foot ulcers is controversial, even when gold standard offloading devices are used, as it is commonly thought to delay healing. We aimed to narratively review relevant studies investigating the relationship between plantar diabetic foot ulcer healing and weight-bearing activity, plantar pressure and device adherence. Reasons for the lack of success of these approaches were likely people’s lack of adherence to these treatment regimens This is probably not surprising considering this approach could mean months of complete non-weight bearing to heal a typical plantar DFU, and DPN often eliminates the trigger of pain that would typically ‘encourage’ people without DPN to reduce their weight-bearing activity on unprotected ulcers. Each type of offloading device can be investigated with the help of this framework, to try to find the optimal balance between ulcer healing and side effects
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
