New research has been published providing unique insights in daily activity of people with diabetic foot ulcers. Queensland researchers Helen Sheahan, Pete Lazzarini and colleagues recruited three groups of patients: with diabetic foot ulcers, with diabetic peripheral neuropathy, and with diabetes mellitus. All three groups were monitored constantly for at least 5 days using a multi-sensor device attached to the patients arm that recorded daily steps, energy expenditure, physical activity, lying duration and sleep duration. The three groups were matched thoroughly, resulting in three groups with comparable demographic and comorbidity characteristics. This is one of the strongest points of the research, as few studies on daily activity actually compare three different groups for such a long period of time in the patient’s everyday environment
The main finding of the paper was that people with diabetic foot ulcers take significantly fewer steps per day, but their daily energy expenditure is significantly higher than the other groups. The authors discuss various explanations for this, at first sight, puzzling finding. It is most likely that this is because of a combination of the energy required for wound healing, the ulcer being a sign of deteriorating general health, and changes in gait. These suggested gait changes, according to the authors, are most likely to be a more rigid gait to compensate for sensory and motor neuropathy.
A limitation of the study was that measurements were only taken during a one week period. It is therefore unknown if these differences remain throughout the ulcer healing period, and whether they affect ulcer healing. For the latter, information on plantar pressures would also have been needed. This provides room for further research on this intriguing topic.
The good news from the study is that people wearing non-removable devices did not show differences in daily activity or energy expenditure from people with removable offloading devices. The devices may be more cumbersome, but they did not seem to restrict the daily activity of patients wearing them.
What this study shows for today’s clinical practice, is that you should realize people with diabetic foot ulcers not only have an ulcer and walk less, but they also require more energy to perform their daily activities perhaps because of their wound healing, changes in their gait or an overall deterioration in health. This may further reduce their physical fitness, as they become less active. This is another reason to try to achieve quick ulcer healing, something that is most likely accomplished with non-removable offloading devices.