The Management of Diabetic Foot Ulcers Through Optimal Off-Loading

Snyder, Robert J.; Frykberg, Robert G.; Rogers, Lee C.; Applewhite, Andrew J.; Bell, Desmond; Bohn, Gregory; Fife, Caroline E.; Jensen, Jeffrey L.; Wilcox, J. R.

doi:10.7547/8750-7315-104.6.555

Cited by 47 publications

(19 citation statements)

References 58 publications

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“…Caution, patient education and compliance are necessary, as inappropriate application may result in new ulcerations and complications such as deformity of toenails, ischaemia, fungal infection and dermatitis, joint rigidity and muscular atrophy. 92 It should be used with caution in deep or heavily draining wounds and in ataxic, blind or severely obese patients. Additionally, any advanced wound-healing adjunctive therapies that require daily applications may not be suitable for use with patients using an off-loading device such as the TCC.…”

Section: Off-loadingmentioning

confidence: 99%

Current concepts for the evaluation and management of diabetic foot ulcers

et al. 2018

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The lifetime risk for diabetic patients to develop a diabetic foot ulcer (DFU) is 25%. In these patients, the risk of amputation is increased and the outcome deteriorates.More than 50% of non-traumatic lower-extremity amputations are related to DFU infections and 85% of all lower-extremity amputations in patients with diabetes are preceded by an ulcer; up to 70% of diabetic patients with a DFU-related amputation die within five years of their amputation.Optimal management of patients with DFUs must include clinical awareness, adequate blood glucose control, periodic foot inspection, custom therapeutic footwear, off-loading in high-risk patients, local wound care, diagnosis and control of osteomyelitis and ischaemia.Cite this article: EFORT Open Rev 2018;3:513-525. DOI: 10.1302/2058-5241.3.180010

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Section: Off-loadingmentioning

confidence: 99%

Current concepts for the evaluation and management of diabetic foot ulcers

et al. 2018

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“…The optimal offloading method associated with the highest rate of full DFU closure in the shortest time is non-removable TCC (an example is Delta-Cast Conformable, BSN medical). [121][122][123][124] The foot is closely fitted with a cast that distributes pressure over the entire plantar surface of the foot. TCC application is highly skilled and should be done by health professionals fully trained in the technique, to minimise the likelihood of rubbing, causing additional damage and to optimise pressure redistribution.…”

Section: Managing the Underlying Condition And Causesmentioning

confidence: 99%

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

et al. 2018

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This is a working document that addresses general principles and provides guidance designed to minimise the likelihood of misdiagnosis and inappropriate management of PUs and DFUs. It should be read and implemented in conjunction with local guidelines. It brings theory and practice together, and offers areas of reflection that allow the reader to review the information and then decide where and how to use it to underpin their own clinical area. The consensus will inform and enable opportunities for practice change.

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“…Guidelines [ 3 , 11 , 12 ] recommend non-removable knee-high devices to heal forefoot ulcers because of their off-loading capacity and ‘forced adherence’. Our pressure measurements demonstrated that a therapeutic shoe with an optimized insole can effectively off-load at least small forefoot ulcers.…”

Section: Discussionmentioning

confidence: 99%

An innovative sealed shoe to off-load and heal diabetic forefoot ulcers – a feasibility study

Jarl

Tranberg

2017

Diabetic Foot & Ankle

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Background: Non-removable knee-high devices are the gold standard to treat diabetic foot ulcers located on the plantar forefoot, but they immobilize the ankle, which restricts daily life activities and has negative effects on joint functioning.Objective: To investigate the feasibility of sealing a therapeutic shoe to off-load and heal diabetic forefoot ulcers.Design: A case series of seven men with type 2 diabetes and a metatarsal head ulcer were prescribed therapeutic shoes and custom-made insoles. The shoe was sealed with a plastic band. Off-loading was assessed with the F-scan pressure measurement system. Adherence to wearing the shoe was assessed with a temperature sensor and by documenting the status of the seal.Results: The off-loading was effective and all ulcers healed. Median time to healing was 56 days (range 8–160). Complications were secondary ulcer (n = 1) and plantar hematoma (n = 1). Five of seven participants did not disturb the seal.Conclusions: Sealing a therapeutic shoe is a feasible way to off-load and heal forefoot ulcers. A controlled trial is needed to compare the effectiveness and safety of a sealed shoe to other non-removable devices.

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The Management of Diabetic Foot Ulcers Through Optimal Off-Loading

Cited by 47 publications

References 58 publications

Current concepts for the evaluation and management of diabetic foot ulcers

Current concepts for the evaluation and management of diabetic foot ulcers

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

An innovative sealed shoe to off-load and heal diabetic forefoot ulcers – a feasibility study

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