A Guide To Preventative Offloading Of Diabetic Foot Ulcers

Author(s): 
Jason R. Hanft, DPM, Daniel T. Hall IV, DPM, and Ashish Kapila, DPM

1. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care. 1990; 13(5):513-521.
2. Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999; 22(1)157-162.
3. Bauman JH, Girling JP, Brand PW. Plantar pressures and trophic ulceration: an evaluation of footwear. J Bone Joint Surg. 1963; 45B(4):652-673.
4. Cavanagh PR, Bus SA. Offloading the diabetic foot for ulcer prevention and healing. J Am Podiatr Med Assoc. 2010; 52(3Suppl):37S-43S.
5. Landsman AS, Meaney DF, Cargill RS, et al. High strain rate tissue deformation: a theory on the mechanical etiology of diabetic foot ulcerations. J Am Podiatr Med Assoc. 1995; 85(10):519-27.
6. Zou D, Mueller MJ, Lott DJ. Effect of peak pressure and pressure gradient on subsurface shear stresses in the neuropathic foot. J Biomech. 2007; 40(4):883-90.
7. Pound N, Chipchase S, Treece K, et al. Ulcer-free survival following management of foot ulcers in diabetes. Diabet Med. 2005; 22(10):1306-9.
8. Snyder RJ, Kirsner RS, Warriner RA, et al. Consensus recommendations of advancing the standard of care for treating neuropathic foot ulcers in patients with diabetes. Ostomy Wound Manage. 2010; 56(4Suppl):S1-24.
9. Lavery LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006; 29(6):1288-1293.
10. Hanft J, et al. The use of the custom molded healing sandal for the treatment of plantar diabetic foot ulcerations. Abstract presented at Joint Annual Meeting and Scientific Seminar, American College of Foot and Ankle Surgeons, February 8-12, 2000, Miami.
11. Van Deursen R. Footwear for the neuropathic patient: offloading and stability. Diabetes Metab Res Rev. 2008; 24(Suppl1):S96-100.
12. Snyder RJ, Lanier KK. Diabetes: offloading difficult wounds. Lower Ext Rev. 2009. Available at http://www.lowerextremityreview.com/article/diabetes-offloading-difficul... .
13. Hanft J, et al. The use of the fixed ankle walker for the treatment of plantar diabetic foot ulcerations. Abstract presented at Joint Annual Meeting and Scientific Seminar, American College of Foot and Ankle Surgeons, Miami, Fla., 2000.
14. Armstrong DG, Lavery LA, Kimbriel HR, Nixon BP, Boulton AJ. Activity patterns of patients with diabetic foot ulceration. Patients with active ulcerations may not adhere to a standard pressure offloading regiment. Diabetes Care. 2003; 26(9):2595-2597.
15. Searle A, Campbell R, Tallon D, Fitzgerald A, Vedhara K. A qualitative approach to understanding the experience of ulceration and healing in the diabetic foot: patient and podiatrist perspective. Wounds. 2005; 17(1):16-26.
16. Crews RT, Armstrong DG, Boulton AJ. A method for assessing offloading compliance. JAPMA. 2009; 99(1):100-103.
17. Aperqvist J, Larsson J, Agardh CD. Long-term prognosis for diabetic patients with foot ulcers. J Int Med. 1993; 233(6)485-491.
18. McGuire J. Diabetes: options for offloading. Lower Ext Rev. 2011. Available at http://www.lowerextremityreview.com/article/diabetes-options-for-offloading .
19. Zgonis T (ed). Surgical Reconstruction of the Diabetic Foot and Ankle. First edition, Lippincott Williams and Wilkins, 2009.
20. Snyder RJ, Lanier KK. Diabetes: Offloading Difficult Wounds Part Two. Lower Ext Rev. 2010. Available at http://www.lowerextremityreview.com/article/diabetes-offloading-difficul... .
21. Delzell E. The role of rocker soles in reducing ulcer risk. Lower Ext Rev. 2011. Available at http://www.lowerextremityreview.com/article/the-role-of-rocker-soles-in-... .
22. Available at http://www.oandp1.com/products/neurocrow.asp .

Comments

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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