Monitoring and Managing the Offloading, Physical Activity Engagement and Fall Risk of Persons with Diabetic Foot Disease

Crews, R T (2020) Monitoring and Managing the Offloading, Physical Activity Engagement and Fall Risk of Persons with Diabetic Foot Disease. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This thesis integrates a series of previously published papers centring around three interrelated themes addressing the complex relationship between diabetic foot ulcers (DFU) and physical activity engagement. The three foci of the thesis include: 1) ‘offloading’ DFU via specialized footwear that limit the application of physical stress to ulcers during weight bearing activity in order to promote healing; 2) monitoring and managing physical activity engagement of both patients at risk for DFU and patients with active DFU; 3) the heightened risk of falls in individuals at risk for DFU. A cohesive underlying foundation of the body of work contained within this thesis is an effort to help care providers and patients achieve better physical activity profiles. Offloading diabetic feet refers to the redistribution of physical stress away from sites at risk for or with active DFU. Thus, it is important to both prevent DFU but also to heal active DFU. This thesis includes two publications pertaining to the objective measurement of patient adherence to offloading modalities as well as two publications regarding the biomechanical assessment of devices used to offload DFU. The need for offloading is necessitated by the fact that individuals with DFU engage in weight bearing physical activity that can inflict physical trauma beyond the tolerance of the soft tissue of their feet, however, the relationship between physical activity and the formation as well as healing of DFU is not fully understood. A series of five publications concerning physical activity within patients with, or at risk for DFU are included in this thesis: two focus on improved monitoring of physical activity and three focus on safely increasing physical activity engagement. Due to a number of interconnected factors, individuals at risk for DFU are also at high risk for falling. The final three publications included in this thesis are devoted to falls risk.