title: 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.
abstract: OBJECTIVE
  To compare the amount of weight-bearing activity and estimates of cumulative plantar tissue stress between subjects with and without diabetes mellitus and a history of recurrent plantar ulcers.
  
  
  METHODS
  Cross-sectional study with matched groups.
  
  
  BACKGROUND
  Weight-bearing activity among individuals with diabetes is likely to influence the amount of mechanical trauma accumulated by plantar tissues, yet activity levels have not been accounted for in previous measurements of plantar tissue stress or predictions of plantar tissue injury.
  
  
  METHODS
  Study groups included subjects with diabetes mellitus and peripheral neuropathy, either with or without a history of recurrent plantar ulcers, and non-diabetic control subjects (n=10 per group). Pressure on the plantar foot was assessed as subjects walked at their preferred speed in the shoes they reported wearing most often each day. Physical activity was monitored over seven consecutive days using an accelerometer. The product of mean daily strides and forefoot pressure-time integral was used to estimate daily cumulative stress on the plantar forefoot.
  
  
  RESULTS
  Subjects with diabetes and a history of recurrent plantar ulcers were 46% less active than subjects without diabetes (mean (SD)=2727 (1345) versus 5037 (2624) strides/day, P=0.04), and accumulated 41% less daily stress on the forefoot than non-diabetic and diabetic control subjects without a history of plantar ulcers (mean (SD)= 210 (134) versus 354 (118) and 354 (148) MPas/day respectively, P=0.03).
  
  
  CONCLUSIONS
  Subjects with diabetes and a history a previous ulcers may be susceptible to plantar tissue injury even at relatively low levels of cumulative tissue stress.
  
  
  CONCLUSIONS
  Changes in weight-bearing activity following plantar tissue injury in patients with diabetes may influence plantar tissue adaptation and the risk of ulcer recurrence.
authors.affiliation: Washington University School of Medicine, Program in Physical Therapy, 4444 Forest Park Blvd, Campus Box 8502, Saint Louis, MO 63108-2212, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Maluf
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
mesh_terms: D000222:Adaptation, Physiological; D001363:Awards and Prizes; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000503:physiopathology*; D016523:Foot Ulcer / Q000209:etiology / Q000503:physiopathology*; D005684:Gait; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D010827:Physiology / Q000266:history; D011312:Pressure; D012008:Recurrence; D012775:Shoes; D012958:Societies, Scientific; D013314:Stress, Mechanical; D016474:Weight-Bearing