On diabetic foot, wound healing, amputation prevention, and the merger of consumer tech with medical devices
For decades, the standard response to a diabetic foot ulcer has been to shut everything down. We focus so intently on offloading that we often inadvertently prescribe a total sedentary lifestyle. But as our colleagues at the University of Michigan point out in their recent review, we need to shift the narrative toward "Toe, Flow,... Continue Reading →
Limb preservation in patients with diabetic foot ulcers (DFUs) is a multifaceted challenge requiring an interdisciplinary approach often captured by the mantra “Toe, Flow, and Go.” This framework integrates the essential contributions of podiatry (toe), vascular surgery (flow), and physical therapy (go) to address the complex needs of high-risk patients. The Role of Each Discipline... Continue Reading →
A study published in The Foot explores the effects of sensorimotor training with an unstable shoe construction (USC) on barefoot pressure distribution in diabetic patients. The randomized controlled trial involved diabetic and non-diabetic groups, examining changes in foot pressure and contact times after a six-week training period. Key Findings: Reduced Pressure: Both diabetic and non-diabetic... Continue Reading →
Great work from Lepesis and coworkers This study evaluated the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs), and balance in people with diabetes, neuropathy, and joint stiffness. The study involved multiple sources for data collection like MEDLINE, EBSCO, Cochrane Database of... Continue Reading →
This compelling work from our plastic surgery toemigos from Kobe and Tokyo. It is similar work to what Dr. Manish Bharara and I did -- just to an entirely new clinical level. High plantar flexor moment and limited ankle mobility are known to cause high plantar pressure under the forefoot. Stretching is an effective physical... Continue Reading →
In our #ToeFlowandGo model, helping people move through their world a little better is a significant goal. One thing that conceptually fits is the use of exercises to improve runoff into the high risk foot. You are familiar with other descriptions of the exercises in this blog. Here is a systematic review by Thakur and... Continue Reading →
Stephanie Woelfel, DPT, Assistant Professor of Clinical Physical Therapy and Surgery, was named President of Academy of Clinical Electrophysiology and Wound Management of the American Physical Therapy Association. The installation took place at this year's APTA meeting in San Antonio. Dr. Woelfel's inauguration honors efforts in leadership to create a dedicated wound healing specialty within... Continue Reading →
