Should weight-bearing activity be reduced during healing of plantar diabetic foot ulcers, even when using appropriate offloading devices?

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

Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

“…However, removable knee-high devices have small desirable effects on reducing more high plantar pressure and activity, but small undesirable effects on adherence compared to removable ankle-high devices [ 10 , 36 , 64 ]. This means, according to best evidence, patients prescribed a removable knee-high device compared to being prescribed a removable ankle-high device are likely to reduce slightly more high plantar pressure [ 58 , 61 , 64 , 65 , 66 , 67 , 68 ], slightly more high weight-bearing activity [ 23 , 34 , 54 , 64 ], but adhere to using their device for slightly less time [ 18 , 19 , 20 , 61 , 64 ]; and these effects balance each other out to give similar healing outcomes [ 10 , 36 , 64 ]. However, this also suggests if patients adhere to using these devices for the same amount of time, then this should result in more high plantar tissue stress being reduced (plantar pressure and activity) and in turn a better healing outcome in those prescribed the knee-high option [ 10 , 11 , 44 ].…”

“…Once prescribed, the most commonly identified barriers in the literature for patients to adhere to using gold standard offloading treatment options include patient misperception, poor mobility, low motivation, and the higher weight of these treatments [ 10 , 18 , 19 , 20 , 23 , 24 , 108 , 109 ]. Firstly, studies indicate patients perceive that they only need to adhere to their offloading treatment for weight-bearing activities outside of their home [ 20 , 24 ].…”

“…Yet, studies have found these different offloading treatments offer different levels of desirable and undesirable effects and in turn produce different healing outcomes [ 9 , 10 , 11 ]. Additionally, studies have indicated that best practice offloading treatments have low rates of use; i.e., low prescription by clinicians [ 8 , 15 , 16 , 17 ] and low adherence by patients [ 18 , 19 , 20 , 21 , 22 , 23 ]. Further studies suggest there are many potential barriers and solutions to the use of these best practice offloading treatments [ 15 , 20 , 21 , 24 ].…”

Prevention of Physical Risk and Rehabilitation of Muscle Injury in Sanda Competition

“…Existing literature [5][6][7] shows that most studies on sanda sports injuries remain in the following aspects, such as injury ratio, injury site, injury type, and analysis and speculation of injury causes, as well as causes and preventive measures for sports injuries. Jarl et al studied the causes of knee joint injuries, the nature of injuries, the relationship between training years and injuries, as well as the diagnosis, treatment, and prevention, and put forward scientific and reasonable methods and suggestions for preventing knee joint injuries [8]. Rother et al found significant differences in injury incidence among athletes of different grades [9].…”

Nanofiber-mediated sequential photothermal antibacteria and macrophage polarization for healing MRSA-infected diabetic wounds

“…Impaired wounds in diabetic patients are difficult to heal which seriously threatens public health [ 1 – 4 ]. Diabetic wounds are clinically chronic complications, and the vulnerability to bacterial infection, especially drug-resistant bacteria, will hinder wound healing in local microenvironments [ 5 – 12 ].…”