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Updated: Jun 6, 2025

Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers
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Diabetic Foot Ulcer Beyond Wound Closure: Clinical Practice Guideline.

Deborah M Wendland1, Elizabeth A Altenburger2, Shelley B Swen3

  • 1Department of Physical Therapy, Mercer University, Atlanta, GA 30341, United States.

Physical Therapy
|November 22, 2024
PubMed
Summary

This guideline addresses gaps in diabetes care, recommending personalized exercise plans and specific foot reloading strategies after ulcer closure to improve quality of life and reduce costs.

Keywords:
Clinical GuidelinesDiabetes MellitusDiabetic Foot

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Area of Science:

  • Endocrinology
  • Sports Medicine
  • Podiatry

Background:

  • Diabetes affects 37.3 million Americans, with 96 million having prediabetes.
  • Hyperglycemia in diabetes elevates risks for complications like skin breakdown and cardiovascular disease.
  • Existing guidelines have gaps in assessing physical fitness, mobility, and post-ulcer foot care in diabetic patients.

Purpose of the Study:

  • To review and assess existing guidelines on diabetes care, focusing on identified gaps.
  • To provide recommendations on screening and interventions for mobility impairments and reduced physical fitness.
  • To establish best practices for diabetic foot ulcer reulceration prevention and post-ulcer foot reloading.

Main Methods:

  • Systematic literature search and review of 701 identified studies.
  • Full-text review of 125 studies, with 38 ultimately included in the analysis.
  • Development of recommendations using specialized software for guideline creation.

Main Results:

  • Recommendations were formulated for incorporating and measuring physical fitness and activity in adults with diabetes.
  • Exercise and physical activity prescription should align with individual physiological responses and preferences.
  • Post-diabetic foot ulcer closure requires maximal offloading for 3 months, followed by titrated loading via footwear.

Conclusions:

  • Personalized exercise prescriptions can enhance quality of life and reduce healthcare costs for individuals with diabetes.
  • Specific protocols for foot reloading after ulcer healing are crucial to prevent recurrence.
  • Further research is needed on exercise's role in wound healing and effective ulcer reloading methods.