The role of activity, adherence, and off-loading on the healing of diabetic foot wounds

The etiology of diabetic foot ulcerations is commonly associated with the presence of peripheral neuropathy and repetitive trauma due to normal walking activities to areas of the foot exposed to moderate or high pressure. The goal of any treatment plan should include as a central tenet the mitigation or modulation of this activity and/or pressure. While numerous studies have detailed the potential pressure off-loading properties of various treatment modalities, subsequent studies have suggested that, if easily removable, these therapies will likely not be used for the majority of steps taken each day. This serves to explain at least in part the often disappointing results of both these pressure off-loading technologies and advanced wound-healing therapies. This article reviews these data and suggests that an amalgam of effective pressure relief coupled with strategies to reduce nonadherence to this therapy could yield a potentially favorable clinical result.