Educating Patients On Mobility Improvement After A Healed Ulceration

Washington University’s Mike Mueller, PT, PhD, FAPTA, offers terrific advice in a recent piece about the importance of mobility in preventing re-ulceration.¹ In his review, the author provides five primary recommendations to share with patients on how to safely improve mobility after healing a lower extremity ulceration.

1. Continue moderate to maximum offloading for one to three months after the wound is healed. The author shares that a sharp increase in activity may increase re-ulceration risk.
2. Wear properly fitting therapeutic shoes to reduce excessive stresses and protect the foot.
3. Slowly increase activity level. The author points out that this may look different for each patient based on factors such as deformity or baseline mobility. This is where working with the patient and an activity monitor (such as a watch, wrist-based, phone-based) can be a game-changer. 
4. Avoid large variations in steps per day. New tissue does not tolerate high levels of stress for even shorter periods of time. Again, activity monitors can help us measure and manage this like never before.
5. Emphasize visual inspection of the feet every day.¹

While these tenets are all familiar to the foot and ankle specialist, this article provides an astute discussion of current evidence and practical applications that may guide providers in educating patients and reducing the risk of re-ulceration.

Dr. Armstrong is a Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s Note: This blog originally appeared at: 

https://diabeticfootonline.com/2019/12/26/mobility-advice-to-prevent-diabeticfoot-reulceration-in-remission/ . It is adapted with permission from the author.

Reference

1. Mueller MJ. Mobility advice to help prevent re-ulceration. Diab Metab Res Rev. 2019. doi: 10.1022/dmrr.3259.