A confluence of numerous factors affect the health of the diabetic foot. Although there is certainly an association between diabetic foot disease and physical activity engagement, this relationship is nuanced and still not fully understood. While too much weightbearing activity can result in the formation of diabetic foot ulcers or prohibit healing, activity avoidance is clearly problematic for overall health and likely detrimental to maintaining resilience of the soft tissue of non-ulcerated diabetic feet. As such, there is likely a “Goldilocks” paradigm in place in which there is a level (or range) of physical activity that is “just right” for each person. This issue’s two audio lectures dive into the challenges of determining that just right dosage of activity for each patient. They also explore timely themes pertaining to the diabetic foot, including COVID-19 and the concept of maintaining activity-rich days for those patients in diabetic foot disease “remission.”

This issue’s commentaries present critical reviews of the latest literature pertaining to managing and monitoring physical activity profiles of patients with diabetic foot disease. In addition to considering the implications of the literature for care providers and patients, the contributors to this issue also address the larger ecosystem of healthcare by considering the role of healthcare payers in promoting lower extremity health. A sampling of the topics addressed by the original manuscripts reviewed by commentators includes: quantification of physical activity profiles, recommendations for managing physical activity levels, advances in offloading the diabetic foot to ensure safe participation in physical activity, and the use of foot temperature monitoring as an early warning system for times when physical activity should be dialed back.

It has been my great privilege to serve as the Guest Editor for this issue of Foot and Ankle Quarterly, and I am immensely grateful to my colleagues that kindly accepted the invitation to join me on this adventure. The international team that has come together for this issue is an all-star roster of clinicians and academics within the field of the diabetic foot. I hope you as a reader will come away from this issue better enabled to partner with patients in managing that “just right” level of physical activity engagement for each patient at each phase of their journey with diabetic foot disease.

Ryan T. Crews, PhD, CCRP