Diabetic foot ulcers and activity pattern

Variable levels of activity appear to precede the development of foot ulcers in people with diabetes, according to a recent study.Researchers from the Rosalind Franklin University of Medicine and Science, USA, explained that many clinicians have long believed that the combination of excessive pressure and frequent mechanical stress produced by physical activity leads to the formation of diabetic foot ulcers. However, a more important factor may be the 'peaks and valleys' in activity, rather than the overall activity. The researchers examined activity levels in 100 diabetic patients, average age 68.5 years, who were at high risk for developing foot ulcers. All the participants wore a computerised activity monitor to measure the number of steps taken over a period of time. The researchers collected data continuously over a minimum of 25 weeks or until ulceration occurred. Eight percent of the subjects developed foot ulcers. Subjects who developed ulcers had significantly lower average daily activity compared with those who did not develop ulcers. However, the variability in the level of activity was much higher in the group that developed ulcers.The pattern of activity appeared to be characterised by periods of inactivity punctuated by relatively sudden pulses of activity over a short period of time. This pattern was most noticeable in the two weeks before an ulcer developed.

The researchers concluded that if this potentially dangerous pulse of activity could be identified, then this information could be provided to the patients or their doctor so they could modify their activity.

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