Inside Insights For Offloading Diabetic Neuropathic Ulcers

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Here is a close-up view of a neuropathic ulcer under the second metatarsal. Dr. Karlock says he is initially aggressive when it comes to offloading the plantar neuropathic ulceration. (Photo courtesy of Lawrence G. Karlock, DPM)
Dr. Karlock notes that most of the literature says 80 percent or more of neuropathic ulcers can be healed within a short period of time with TCC, but the time-consuming nature of the modality thwarts more mainstream use. (Photo courtesy of David G. Armstr
Converting a removable cast walker into an instant total contact cast may help facilitate easier application and increase patient compliance, according to Dr. Armstrong. (Photo courtesy of David G. Armstrong, DPM)
Clinical Editor: Lawrence Karlock, DPM

Dr. Kravitz is a Fellow of the American College of Foot and Ankle Surgeons, and the American Professional Wound Care Association. He is an Assistant Professor in the Department of Orthopedics and is on the clinical faculty for the Advanced Wound Healing Center at the Temple University School of Podiatric Medicine.

Dr. Karlock (pictured) is a Fellow of the American College of Foot and Ankle Surgeons and practices in Austintown, Ohio. He is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.


1. Armstrong DG, Short B, Nixon BP, Boulton AJM: Technique for fabrication of an “instant” total contact cast for treatment of neuropathic diabetic foot ulcers. JAPMA 2002; 92:405-408.
2. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL: Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. A comparison of treatments. Diabetes Care 1996; 19(8):818-21.
3. Armstrong DG, Lavery LA, Kimbriel HR, Nixon BP, Boulton AJM: Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure offloading regimen. Diabetes Care 2003; 26(9):2595-2597

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