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

Malindu E. Fernando, Stephanie L. Woelfel, Diana Perry, Bijan Najafi, Tanzim Khan, Charles Dubourdieu, Laura Shin, David G. Armstrong

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
JournalJournal of the American Podiatric Medical Association
Volume111
Issue number5
DOIs
StatePublished - Sep 2021

ASJC Scopus subject areas

  • Podiatry
  • Orthopedics and Sports Medicine

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