SALSA/Rancho Los Amigos Guidelines for Return To Activity in Remission #ToeFlowandGo @USC @RanchoResearchI @USC_Vascular

Here are the instructions we give our patients upon returning to prescriptive shoes / activity following healing of a diabetic foot ulcer, foot reconstruction or partial foot amputation in remission.

Dosing Activity and Returning to Pre-Ulcer function in Diabetic Foot Remission: Guidelines from SALSA and Rancho Los Amigos


Shoe Wear Schedule:

Day 1Day 2Day 3Day 4Day 5
30 min.1 hr2 hr4 hr8 hr
  • After each trial of wearing the new shoes, immediately remove your shoes and socks and perform a foot inspection (toes, top and bottom of foot) looking for any reddened areas or new areas of callous.
  • If no redness/callus, next day proceed to increased wear time
  • If redness, but it resolves in 15 minutes or less, next day proceed to increased wear time.
  • If redness lasts longer than 15 minutes – do not increase the wear time, follow-up with orthotist as adjustments likely need to be made
  • Any new areas of callus should be monitored and discussed with your podiatrist and orthotist so the callous can be shaved regularly and any needed shoe modifications can be made.

Return to Activity:

This return to activity schedule should not be initiated until you are up to 8 hours+ wearing new custom footwear. You should definitely be wearing the custom footwear when being active.

Week 1Week 2Week 3Week 4Week 5
1,000 steps/day2,000 steps/day3,000 steps/day4,000 steps/day5,000 steps per day

Use a fitness tracker (Fitbit, Garmin, Apple Watch, Samsung, etc.) or smart phone to track your daily steps.

As long as you are using the same device consistently for tracking you should be fine.

If at any time, daily skin checks of your feet show prolonged redness (> 15 minutes), stay at that same daily step count (or decrease slightly) until you are no longer seeing the redness and also consider that modifications may be needed for your shoes.

Activities to (potentially) avoid:

Some activities are likely to create significantly more shear and friction at the bottom of your foot and should be avoided in an effort to prevent another wound. These would include:

  • Elliptical machine
  • Rowing machine
  • Leg press
  • Treadmill (could be used intermittently but walking regularly is preferred)
  • If you have a gym regimen you would like to get back to, please let us know and we can make adjustments as needed

In addition to walking, strength training has very beneficial effects for diabetes management (blood sugar control, relief of neuropathy symptoms, overall improvement in function). If this is something you are interested in, we can definitely discuss this further as well.

Skin Temperature: Wounds often heat up before they break down

If you have a personal thermometer, you can dose your activity by checking your skin temperature just as you might dose your insulin by checking your glucose. Please see here for more info on how to map your foot for hotspots and communicate this with your clinician.

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