Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

BIG FOOT. Assessing the feet and footwear of obese patients with diabetes when recommending an increase in weight-bearing activity (#65)

Anna Crawford 1
  1. Great Feets Podiatry, Redfern, NSW, Australia

The benefits of exercise for people with diabetes mellitus and obesity are widely accepted and include weight loss and improvements in insulin action and overall quality of life. Historically, patients with severe peripheral neuropathy have been advised not to participate in weight-bearing activities, however more recent evidence has prompted a change in this thinking. The current ACSM and ADA Joint Positional Statement on Exercise and Type 2 Diabetes (2010) states that ‘individuals with peripheral neuropathy and without acute ulceration may participate in moderate weight-bearing exercise’, with the proviso that ‘inspection of feet and use of proper footwear is recommended for prevention and early detection of sores or ulcers’.  

High plantar pressures in the presence of sensory neuropathy and foot deformity are common determinants of diabetic foot ulceration. Obesity has been shown to further increase the susceptibility of these feet to ulceration. Understanding the aetiology of ulceration (chronic and acute) is therefore important in managing obese diabetic patients. It is also imperative to conduct thorough assessments of the foot and footwear, and to properly understand the implications of these assessments’ findings. By these means we can minimize the risk of skin breakdown in obese patients with diabetes prior to their commencement of an appropriate weight-bearing exercise regimen.