Neuropathic changes, along with other diabetes-related complications, heighten the risk for skin ulceration in people with diabetes. While offloading facilitates wound closure, the skin of a closed wound is at risk for reulceration. Also, people with diabetes, including those with a history of ulceration, need to be physically active to promote glycemic control.
To review the effects of walking exercise on skin tissue properties and to discuss techniques that may facilitate reloading tissue following wound closure to progressively assist patients in meeting the recommendations for physical activity.
Following offloading to close neuropathic ulcers, a controlled progression of reloading is important to facilitate the skin's tolerance to stresses so that a patient can return to function. Reloading can be titrated by altering the magnitude, duration, and direction of forces. Also, principles of exercise prescription are important to utilize in the context of diabetes management and skin healing.
For disease management, patient quality of life, return to function, and health promotion, it is imperative that physical therapists use progressively controlled exercise prescription to lead the way in a holistic approach to care for people with diabetes.