Hi there, my name is Stephanie Woelfel, I'm a Doctor of Physical Therapy and a board certified wound specialist through the American Board of Wound Management and the American Board of Physical Therapy Specialties. I am currently an Associate Professor of Clinical Physical Therapy with a dual faculty appointment in the Department of Surgery at the University of Southern California. 

Ulcer remission is really that period when the wound closes but we don't you know haven't gone through the time frame yet where we would consider it healed. So we think about the correlation to patients with cancer, where they go into remission, but there's a much longer period of time before their cancer would be considered cured or something like that.

So we're trying to think of wounds in a similar way, especially the wounds that tend to recur frequently. So think about diabetic foot ulcers, venous leg ulcers, those wounds that can tend to recur and come back over time.

So we think of this term of ulcer remission as where that wound is closed, but the patient still needs to be actively monitored, right? So we're looking at, are we still using protective dressings in the case of the diabetic foot? How are we offloading? How are we reintroducing them to activity? And really, the thought behind wound remission is that the more we can kind of have a very concrete and objective way that we manage these patients as they move into remission and then continue down their healing path, hopefully the longer we're keeping them out of the clinic, the longer they're living a healthy active life without having a wound. So, I think this is something that we're trying to introduce as far as this idea of wound remission as kind of this other phase maybe of healing because we're trying to prevent recurrence or at least extend the period of healing between recurrences for these patients.

And I think the other part of this idea of remission and the types of monitoring and kind of active management that we're doing during that timeframe is that if a wound does recur, that we're catching it really early in that process. So that maybe instead of this patient coming back in and having to go through several more months. of wound care for a recurrence, if we can catch that really early, then maybe it's a slight tweak and they only have to do, you know, their their wound care for an additional week or something like that.

And we can kind of make the adjustments, whether it's in their orthotic or their offloading or their compression, that can kind of make the difference before it gets to the point where it's the you know, really full -blown wound situation again. So I think ways to think about, you know, supporting this idea of the diabetic foot ulcer and remission is really to make this part of your practice. Because oftentimes we know that these patients have kind of ongoing needs as far as education, different things like that.

So I really think making this kind of a concrete part of your program can be really powerful. So, you know, making sure that the patient knows how to do their daily foot exams, and that they have the range of motion that and the eyesight, the vision that they need to do those things. If not, who can they call? You know, do they do that? They have a family member? Do they have a friend? Can you put them into a foot selfie program so that someone else is kind of checking in on their feet and helping them with that? You know, making sure that they have really good foot gear that they the right kind of orthotic and the right kind of shoe, and that they understand that if the orthotic isn't fitting correctly, maybe they are seeing a little bit of rubbing or a little bit of a red spot, that does not mean you stop wearing that shoe and you go back to your old one.

Okay, we see that a lot where they're like, oh, well, the orthotic didn't work. And it's like, well, what do you mean it didn't work? Oh, I was getting a little red spot. Okay, that just means we have to go back in and see the orthotic and we have to get that fixed.

It doesn't mean that you stop wearing these altogether and go back to the thing that caused your wound in the first place. So there's a lot of things that come up after a wound closes that patients still need help navigating, talking with them about their return to activity, having someone that we've been offloading for months, just all of a sudden getting back into shoe gear and doing whatever the heck they feel like doing is not going to be something that's going to help to sustain that wound remission, right? It's likely that they're going to fall back into a pattern that probably contributed to the wound in the first place. So we have to be those, you know, those educators, those people that are really traveling this road with them.

And that doesn't mean giving them a barrage of information at their last visit and thinking that they're going to remember all of that or know how to apply it. And that's where I think as physical therapists we can play a really big role in this because you know we are experts at movement analysis, we understand what patients need to do to kind of you know titrate their activity, we can help them monitor their step counts, different things like this.

So I think if you don't have PTs involved, that potentially looking for a way to bring them into your remission clinic or remission part of your practice could be a really helpful way to help your patients kind of extend that remission and have more time before they might have a recurrence.