Over the course of their life, a person with diabetes may walk a tightrope when it comes to caring for their feet. They may be teetering between getting too much activity, which can lead to foot ulcers, and too little activity, which can dampen the effect of insulin and increase the risk of nerve damage. But between provider and patient, there are methods that can put a harness on the tightrope walker and help improve foot care overall.

This topic will be covered in The Goldilocks Paradigm of Physical Activity and the Foot in Persons with Diabetes on Saturday, June 24, at 8:00 a.m. PT in Room 28 of the San Diego Convention Center. The symposium also will be available via livestream for registered meeting participants.

“The most common reason that someone with diabetes will be admitted to the hospital is not for high blood sugar or low blood sugar. It’s not for a heart attack or a stroke. It’s for a foot problem,” said David G. Armstrong, DPM, MD, PhD, Professor of Surgery and Director of the Southwestern Academic Limb Salvage Alliance at Keck School of Medicine, University of Southern California.

Dr. Armstrong is among three symposium presenters and will focus on where science stands in managing activity levels for people living with diabetes. He sees the potential for providers to use tools like temperature-sensitive patches and insulin-tracking technology to determine when a patient may be at risk for foot injury.

“Data have emerged just over the last several years that show that this really can work well—and work really inexpensively and be scaled up around the world,” he said.

In addition, the use of smartphones has begun helping clinicians create activity prescriptions for their patients. Similar to Goldilocks from the children’s story finding the perfect bowl of porridge or bed to suit her, when tracking glucose levels using a smartphone and reporting those to their provider, patients can find their activity sweet spot.

But to get to that sweet spot, there are multiple considerations, said Kristin Schneider, PhD, Associate Dean of Research at Rosalind Franklin University of Medicine and Science. She will focus on a different angle that may complicate the foot care equation: mental health.

“I’ll be highlighting some of the unique challenges that people with diabetes have to deal with and talking about some strategies to help address those barriers so that we can encourage people to be more active while keeping them safe,” she said.

The psychological burden that people with diabetes often endure may contribute to a sedentary lifestyle. It’s common for them to struggle with depression and bodily pains, both of which get in the way of exercise.

In her training as a psychologist, Dr. Schneider has often observed this phenomenon. She urges providers to think about the unique factors that may motivate their patients to be active, such as a provider counseling someone recovering from a foot ulcer to start with a tapered reintroduction to physical activity to prevent another injury.

“There are unique considerations for patients who are either at risk for a diabetic foot ulcer or experienced a diabetic foot ulcer previously with respect to encouraging them to be physically active,” she said.

Shaima Alothman, PT, PhD, Deputy Head of the Lifestyle & Health Research Center, Princess Nourah bint Abdulrahman University, Saudi Arabia, will discuss physical activity recommendations for patients with diabetes foot disease.