Weight-bearing activity and plantar diabetic foot ulcers

Physical activity has a positive effect on health, also and especially in patients with diabetes. It becomes problematic when diabetic patients suffer from a plantar foot ulcer. How do you find the balance between necessary exercise and optimal wound healing? Science does not yet have clear answers to this according to a review of several studies on this topic.

At the heart of any treatment for a diabetic foot ulcer are assistive devices to relieve pressure on the foot. However, even when assistive devices that meet the gold standard for offloading are used, the plantar load of the foot ulcer cannot be completely eliminated. The question of whether concerns that weight-bearing activities can significantly delay healing was addressed by a group of researchers from Sweden, Australia, the Netherlands, and the United States. For their review using the Pubmed library, they identified six relevant studies to this question. But after the evaluation, there was unfortunately no clarity. Statements in the studies showed conflicting results on how to offload a foot with a diabetic foot ulcer to help wound healing. One study found that increasing the number of steps was associated with poorer ulcer healing. However, three other studies found no association between wound healing and the length of time patients walked. In two other studies, the association was unclear. In addition, the studies revealed methodological weaknesses in some cases, so that the results can only be evaluated to a limited extent.

To help guide future studies, the authors propose a framework that maps key wound healing factors, such as vertical pressures, shear forces, gait, balance, and daily activities. This should allow any type of offloading device to be studied to find the optimal balance between ulcer healing and side effects.

The full study can be found here.