Current Concepts In Offloading Diabetic Foot Ulcers

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Ryan H. Fitzgerald, DPM

1. Canavan RJ, et al. Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: continuous longitudinal monitoring using a standard method. Diabetes Care 2008; 31(3):459-63.
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5. Armstrong DG, Wrobel J and Robbins JM. Guest editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J 2007; 4(4):286-7.
6. Jeffcoate WJ, et al. Unresolved issues in the management of ulcers of the foot in diabetes. Diabet Med 2008; 25(12):1380-9.
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11. Armstrong DG and Athanasiou KA. The edge effect: how and why wounds grow in size and depth. Clin Podiatr Med Surg 1998; 15(1):105-8.
12. Wu SC, Crews RT and Armstrong DG. The pivotal role of offloading in the management of neuropathic foot ulceration. Curr Diab Rep 2005; 5(6):423-9.
13. Blanc Y, et al. Temporal parameters and patterns of the foot roll over during walking: normative data for healthy adults. Gait Posture 1999; 10(2):97-108.
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15. Van Schie CH, et al. Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in Caucasian diabetic men. Diabetes Care 2004; 27(7):1668-73.
16. Armstrong DG, et al. Quality of life in healing diabetic wounds: does the end justify the means? J Foot Ankle Surg 2008; 47(4):278-82.
17. Armstrong DG, et al. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 2001; 24(6):1019-22.
18. Katz IA, et al. A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care 2005; 28(3):555-9.
19. Armstrong DG, et al. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 2005; 28(3):551-4.

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Matthew Carrollsays: August 26, 2009 at 10:20 am

I am surprised Dr. Fitzgerald omitted mention of the VACOcast Diabetic Foot line of ulcer offloading devices (, Framingham, MA). This boot is an RCW that incorporates a vacuum beanbag for a more "total contact" fit and it comes with an optional "locking seal" that makes it an iTCC without having to jerry-rig with a cohesive bandage. It is closer to a TCC than alternatives.

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