Diabetic Foot Ulcers Linked With Less Steps
Issue 220 Item 3

The more steps taken, the less risk for foot ulcers. Diabetics who develop foot ulcers appear to have lower levels of overall activity than their counterparts who do not develop ulceration, and "the quality of that activity may be more variable," according to a report in the August issue of Diabetic Care.

Dr. David G. Armstrong, of Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, and colleagues examined the role of activity in the development of neuropathic foot ulcers in diabetics.

A total of 100 consecutive diabetics (mean age 68.5 years) with concomitant neuropathy, deformity, and/or lower extremity ulceration/partial foot amputation were included in an ongoing prospective longitudinal activity study.

All patients used a high-capacity continuous computerized 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. The mean follow-up was 37.1 weeks.

Eight percent of the subjects developed foot ulcers. Subjects who developed ulcers had significantly lower average daily activity compared with those who did develop ulcers (p = 0.03).

Significant variability was observed between the groups. Compared with the group without ulcers, the coefficient of variation was significantly greater in those who ulcerated (p = 0.0001). "Furthermore, in the 2 weeks preceding the ulcerative event, the coefficient of variation increased even further," they report.

If this potentially dangerous "pulse" of activity can be identified, maybe this information can be provided to the patients or their doctor so they can modify their activity — "essentially smoothing out those peaks and valleys of activity," Dr. Armstrong told Reuters Health.

"One device we’re working on is a similar activity monitor, but one that will identify when the patient’s protective shoes are being worn and when they’re not," Dr. Armstrong explain. "This can help better structure preventative care." Diabetes Care 2004;27:1980-1984.
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