About ~7-8 years ago I was on a panel as part of a diabetes and exercise session at a sports medicine conference. I was the last one to speak -- all the rest of the panel (diabetes physcian; dietitian; exercise physiologist) all gave glowing reports on the benefits of exercise etc etc for those with diabetes.... I then got up and talked about the increased risk for stress fractures; the dangers of weightbearing activity on the neuropathic foot; the biomechanical consequences of LJM; etc .... talk about giving them the bad news...
I also recall either some data or a comment from a while back that there is an increase in lower limb amputation in those who have had a renal transplant purely because of the increased acticity levels that follow the surgey (no more sitting around all day on dialysis) .... so that research above does make sense and contains a cautionary tale we all should be aware of.
Craig,
Another reason for the increase in amputation in Renal transplant patients with diabetes is the fact that they usually have severe ischaemia, and are often too ill to have reconstructive surgery. The transplant surgery can often throw off emboli which then block off pedal ateries as well. All in all not a good combination to have !
I am always at aloose end to understand a
diseasemanagment approach which relies so heavily upon self care which involves exercise as part of prevention and or rehabilitation,yet singularly ignores the importance of footwear.I think it is close to abdication of a duty of care
Cameron,
I absolutely and wholeheartedly agree with you.
I have seen far too many feet damaged by footwear after patients have been told by well meaning Drs and nurses to take more exercise, without giving any note or information about footwear or even footcare!
Just telling patients to wear training shoes would help, nut even this isnt done in the majority of cases.
Feet just arent sexy enough ! and are therefore ignored, even though the associated costs (both directly and indirectly ) are huge.