Current Concepts In Offloading Diabetic Foot Ulcers

Ryan H. Fitzgerald, DPM

In Conclusion

   Advances in wound healing technology have greatly expanded the physician’s ability to effectively manage DFUs and thus prevent lower extremity amputations. However, one must not neglect the importance of simple offloading to reduce pressure forces at the wound site. Excess shear and vertical forces, particularly in the context of sensorimotor neuropathy, can create a repetitive stress injury that leads to ulceration in the lower extremity.

   Advances in offloading techniques can reduce the aforementioned forces at the wound site and have increased efficiency. It is also important to remember that proper wound debridement with a particular emphasis in appropriately managing the wound margins to reduce the “edge effect” is necessary prior to the utilization of an offloading device.

   With any of these therapies, patient adherence is of supreme importance. Considering the significant morbidity and mortality associated with the development of lower extremity ulcerations, it is vital that patients understand the risks and consequences of non-adherence.

Dr. Fitzgerald is a Diabetic Limb Salvage Fellow at Georgetown University Hospital in Washington, DC.

Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a
Fellow of the American College of Foot and Ankle Surgeons.


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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