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Can Unprotected Standing Delay DFU Healing?

We like to tell our patients they should stop sitting down. They should get up and stand because sitting, for many patients or perhaps for the population in general, can be thought of as the new smoking. However, for our most high-risk patients, it seems that standing can also be dangerous. A new study by our team in the Journal of Diabetes Science and Technology finds unprotected standing may be “an even more unrealized and sinister culprit” in wound healing delays.1

In the randomized study, we assessed 49 people with diabetic foot ulcers, who utilized either a removable cast walker (RCW) or an irremovable instant total contact cast (iTCC).1 The study noted that more patients wearing iTCCs healed at 12 weeks. At four weeks, authors noted significant differences in activity between the groups. They found that patients wearing RCWs were more active than those wearing iTCCs as RCW patients had a 75 percent higher duration of standing, a 100 percent longer duration of walking and 126 percent longer unbroken walking periods. The study found those wearing RCWs had a significant inverse correlation between the duration of daily standing and the weekly rate of healing.

We say “It’s not what you put on the wound but what you take off” that helps the wound heal. That seems to be true — particularly in this case. We see that the irremovable devices are far superior to the removable devices in terms of rate of healing.

Why is this? The answer is still rather elusive. It does appear that standing in this study may be associated with more faulty healing. When patients with diabetic foot ulcers are standing, they may be standing using a more rigid posture than a person without postural instability. In a very small sense, they are cutting off circulation to small areas of the foot and not moving around a lot like we would normally see in a person who did not have the postural stability problems that are inherent with diabetes and neuropathy. This could be causing focal pressure-related ischemia reperfusion injuries.

We really look forward to further works in this area to see what is actually causing this association. We also believe that activity is much more important than just steps. We think that it is the overall daily collection of activity that we will be dosing in the future just as we now dose a drug.


1. Najafi B, Grewal GS, Bharara M, et al. Can’t stand the pressure: the association between unprotected standing, walking and wound healing in people with diabetes. J Diabetes Sci Technol. 2016; epub Aug. 10.

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