MU Researcher Suggests Diabetics with Previous Foot Ulcer Complications may be able to Participate in Walking Program

The late Paul Brand, the now legendary medical director of the
Hansen’s Disease center in Carville, Louisiana, was quoted as saying
“a wound will heat up before it breaks down”. He was, of course,
correct in this assertion. This led many (including me) to assume
something of a linear conceptual relationship between steps,
inflammation, and skin breakdown.  What we now are coming to see are
individual kernels of evidence to support that this may not be the
case. Several years ago, our unit and the outstanding one at
Washington University in St. Louis published works that suggested
that, when followed longitudinally, neuropathic people that ulcerated
seemed to be slightly less active  than those matched subjects that
didn’t ulcerate.1, 2 The elegant work of Joe Lemaster is continuing to
interrogate and expand on these findings. The end result of this work
may soon find us continuing our work as “activity doctors”. We now
dispense personal skin thermometers to our patients and work with them
to dose their activity (while monitoring their skin temperature for
“hot spots” of pre-ulcerative inflammation) much as we would dose a
drug. In this manner, we might now be able to get patients up into
their ideal therapeutic range.

 Bibliography
1.      Maluf KS, Mueller MJ. Novel Award 2002. Comparison of physical
activity and cumulative plantar tissue stress among subjects with and
without diabetes mellitus and a history of recurrent plantar ulcers.
Clin Biomech (Bristol, Avon). Aug 2003;18(7):567-575.
2.      Armstrong DG, Lavery LA, Holtz-Neiderer K, et al. Variability in
activity may precede diabetic foot ulceration. Diabetes Care. Aug
2004;27(8):1980-1984.