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Case Reports |
DJ Lott, PT, MSPT, CSCS, is Doctoral Candidate, Movement Science Program, Washington University, St Louis, Mo
KS Maluf, PT, PhD, is Post-Doctoral Research Associate, Department of Integrative Physiology, University of Colorado, Boulder, Colo
DR Sinacore, PT, PhD, is Associate Professor, Program in Physical Therapy and Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo
MJ Mueller, PT, PhD, FAPTA, is Associate Professor, Program in Physical Therapy, Washington University School of Medicine
Dr Maluf and Dr Mueller provided concept/idea/project design. All authors provided writing. Dr Maluf and Dr Sinacore provided data collection, and Dr Maluf provided data analysis. Dr Sinacore provided the patient. Dr Mueller provided facilities/equipment. Dr Maluf, Dr Sinacore, and Dr Mueller provided consultation (including review of manuscript before submission)
Address all correspondence to Mr Lott at Program in Physical Therapy, Washington University, Campus Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108-2212 (USA) (Djlott{at}artsci.wustl.edu)
Background and Purpose. Although pressure-reducing interventions have been effective in the healing of neuropathic foot ulcers, these ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to ulcer recurrence for this patient. Case Description. The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent plantar ulcers. His plantar ulcer healed after total contact casting. Outcome. Despite relatively low peak plantar pressure (9.3 N/cm2), the patient's ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative plantar tissue stress that was 3.3 times higher on the day of ulcer recurrence than his average value. Although his cumulative plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent ulcers. Discussion. Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of ulcer recurrence.
Key Words: Diabetes mellitus • Foot • Stress • Ulcer
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