DiabeticLifestyle is now OnTrackDiabetes.com! Learn more.

Too Much Standing: Why Your Foot Wound Won't Heal

too much standing can interfere with wound healingNew study finds standing may interfere with diabetes-related wound healing as much, and possibly more, than walking.

We all know too much sitting is bad for us, making us prone to weight gain and other issues. However, too much standing may not be good, either, especially if you have diabetes-related foot ulcers or wounds or are at high risk for them.

Excessive standing ''is the major reason for failure in [diabetes-related] wound healing," says study lead author Bijan Najafi, PhD, professor of surgery and director of clinical research in the division of vascular surgery and endovascular therapy at Baylor College of Medicine in Houston, Texas. While standing is often perceived as less harmful than walking when you have a foot wound, his new research suggests that is not true, he tells DiabeticLifestyle.1

What the Study Found

Najafi's team followed 49 people with diabetic foot ulcers, assigning them to wear a removable cast walker (also known as a boot) or a non-removal cast. Over the course of 12 weeks, the researchers looked at changes in wound size and each person's physical activities, including walking and standing. At the end of 12 weeks, they found that the more people walked, the slower the healing, not surprisingly. But unprotected standing appears to affect it the most.

At week four, the group with the removable prescribed footwear became more active, and the researchers speculate that as a result they were less compliant to instructions to wear the cast to promote healing. But the standing pattern affected healing in both groups.

Bottom line? "While walking may delay wound healing, unprotected standing might be an even more unrealized and sinister culprit," the authors conclude.

The study is published in the July 2017 issue of the Journal of Diabetes Science and Technology.1


Explaining the Findings

The ill effect of standing on wound healing may be partially due to a finding from one of Dr. Najafi's other studies. He found that people with diabetes tend to stand three times as much as they walk, and the duration of standing is often more prolonged that the period of continuous walking.

"While unprotected walking is bad, unprotected standing could be worse,'' he says, since it involves sustained pressure on the foot and a lack of blood flow. "Patients may consider standing as safe and may not use the protective foot gear while standing," he says. Those are only speculative explanations, he says, as to why standing delays healing. More study is needed.

Meanwhile, he says: "Overall, daily standing periods had twice the negative impact on the speed of wound healing than daily walking periods.'' He notes, however, that that could be affected simply by the length of time most people stand versus walk.

Bottom Line Advice

"People with diabetes and foot ulcers or at high risk of them, need protective foot wear if standing or walking," he says. He prohibits bare feet. "Barefoot is bad," he says.

In the new study, the researchers did not examine the patterns or duration of standing. However, experts generally concur that those with pressure ulcers should not have sustained pressure on their foot for more than 15 minutes. "Thus probably continuous standing over 15 minutes could be risky for people at higher risk of diabetic foot ulcer," he says.

If plantar ulcers are present, any unprotected foot loading should be avoided, he says, including walking and standing. However, more study is needed to confirm that, he says.

Perspective

The study confirms that ''not only is walking on an ulcer detrimental to healing but also standing.'' Says Andrew Boulton, MD, FACP, FRCP, professor of medicine at the University of Manchester. In his own research, he found that patients with nerve problems have a reduced recovery of blood flow after standing for a period of time, which is an abnormal response.

The study is a good reminder for those with diabetes and a foot wound that they should stay off it, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, a registered dietitian and certified diabetes educator and transitional program coordinator at the Kovler Diabetes Center in Chicago and a member of the Endocrine Web editorial board. She reviewed the new findings.

These results do illustrate the need for health care providers to give the advice more aggressively, she says, to be sure those with foot wounds or ulcers are truly limiting the amount of time they stand.

One way to reduce standing, she says, is to be sure you have a chair handy. If you're on the go, consider a light, portable chair to carry with you. "There are a few that double as a cane or walker, too," she says.

Dr. Najaf reports no disclosures.

 

Updated on: July 19, 2017
Continue Reading
Diabetes & Your Feet: 5 Things You Need to Do Right Now to Prevent Ulcers, Infection, Amputation
MAIN MENU