A Guide To Preventative Offloading Of Diabetic Foot Ulcers

Jason R. Hanft, DPM, Daniel T. Hall IV, DPM, and Ashish Kapila, DPM

   Future offloading devices should incorporate aspects that would increase adherence. Qualities of these offloading devices should include: comfort, durability and ease in application, all of which serve as a construct to prevent secondary ulcerations. While this may seem obvious to many, these core issues have not adequately been incorporated into one device. Perhaps we are underestimating the importance of these devices in limb and life salvage, and should redirect our attention toward new offloading technology.

   Offloading is a very important aspect of wound healing that may often be undervalued. Diabetic foot ulcers are caused by a combination of pressure and strain. Effective offloading requires reduction of both of these forces. Currently, there is no perfect device. However, we do have the tools at our disposal that can yield very high healing rates. By recognizing the shortcomings of the offloading devices and tailoring the device to the specific needs of the patient along with proper patient education, we can drastically improve clinical outcomes.

   Dr. Hanft is the Director of Podiatric Medical Education at Baptist Health in South Florida. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Hall is a first-year resident at South Miami Hospital.

   Dr. Kapila is a second-year resident at South Miami Hospital.



I am still amazed how often people talk about compliance with the use of these offloading devices but never mention the severity of leg length discrepancy they cause. A shoe build up makes walking so much easier. Try adding 2 cm to the sole of the shoe on the non-affected side. Then maybe you will be amazed how compliance improves.

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