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Emerging Insights On Ex-Fix Offloading For Diabetic Foot Ulcers

William P. Grant, DPM, FACFAS, Lisa M. Grant, and Bryan R. Barbato, BS | 12,490 reads | 0 comments | 03/25/2013

It is well understood that unremitting pressure is a major etiologic factor in both the creation and persistence of diabetic foot ulcers. Sensory neuropathy in combination with autonomic and motor neuropathy readily produces foot deformities with bony prominences and skin lacking normal protective sensibility. Further complicating the problem, alteration in tendon morphology and its function produces increased plantar pressures as well as temporal alteration in the phasic gait cycle that can destroy the protective barrier of the skin beneath the foot.

When Offloading Devices Are Harder To Remove, Are Wounds Easier To Heal?

David G. Armstrong DPM MD PhD | 3,740 reads | 0 comments | 01/22/2013

Here's an intriguing meta-analysis from a team in Adelaide in South Australia. In a recently published study in Diabetes/Metabolism Research and Reviews, Morona and colleagues compared different offloading devices for neuropathic foot ulcers in patients with diabetes.1

The researchers searched medical bibliographic databases, the Internet and reference lists from January 1966 to May 2012. They focused on systematic reviews and controlled studies comparing the use of different offloading devices.

In Search Of An Offloading Standard

By Jeff Hall, Editor-in-Chief | 2,632 reads | 0 comments | 11/03/2003

When it comes to multicenter clinical trials for various wound care modalities, it stands to reason all the elements of the study should be constant with the key variable being the modality or modalities one is comparing in order to determine the efficacy. However, what if one of those study elements (say offloading) is handled differently by the researchers involved in the study? Wouldn’t that detract from the validity of the results?

A Guide To Surgical Offloading In The Neuropathic Foot

By Rachel Grieder, DPM, Sean McMurray, DPM, and Matthew J. Claxton, DPM | 14,833 reads | 0 comments | 03/03/2007

      The neuropathic foot presents unique challenges when treating and preventing chronic wounds. One of the most difficult challenges is offloading the neuropathic foot without compromising function or causing a transfer of pressure that leads to further ulceration. When performing a limb salvage procedure, the goal is to provide the patient with a stable, plantargrade foot while still allowing for ambulation.1       In choosing the appropriate procedure to offload the foot, it is important to consider minimal bone resection versus a partial pedal amputation.

Current Concepts In Surgical Offloading Of DFUs

Howard Kimmel, DPM, MBA, Jennifer Regler, DPM, and Jeremy Gray, DPM | 11,714 reads | 0 comments | 06/26/2009

When one ensures proper patient selection, surgical offloading may offer key benefits for patients with diabetic foot ulcerations. Accordingly, these authors offer insights and review study findings on the use of flexor tenotomies, metatarsal head resection, Achilles tendon lengthening and external fixation to help facilitate optimal outcomes.

Key Insights On Offloading Diabetic Neuropathic Ulcers

Kazu Suzuki, DPM, CWS | 12,581 reads | 0 comments | 06/26/2009

   Offloading a wound is a critical component of facilitating optimal outcomes with healing. Accordingly, these expert panelists discuss the use of total contact casting (TCC) to offload diabetic neuropathic wounds as well as the impact of instant total contact casting (iTCC) and other offloading methods.

   Q: As far as offloading devices go for diabetic/neuropathic foot ulcers, do you use total contact casting?

Pertinent Pointers On Offloading Diabetic Foot Ulcerations

Kristine Hoffman, DPM, Jeffrey L. Jensen, DPM, FACFAS, and Eric D. Jaakola, DPM | 14,549 reads | 1 comments | 02/23/2010

Offloading plays a key role in the management of diabetic foot ulcerations. With this in mind, these authors review the literature and discuss a variety of modalities ranging from non-weightbearing options and therapeutic half-shoes to removable cast walkers and total contact casts.

Current Concepts In Offloading Diabetic Foot Ulcers

Ryan H. Fitzgerald, DPM | 17,188 reads | 1 comments | 08/24/2009

   As the prevalence of diabetes mellitus increases worldwide, there will be a concomitant increase in the development of the lower extremity manifestations of the disease process. In the United States alone, there are currently an estimated 24 million patients living with diabetes.1,2 Given the reported 15 percent lifetime incidence for the development of lower extremity ulcerations in this patient population, this equates to approximately 3.6 million diabetic foot ulcers (DFUs).3

Modified SALSAstand Fixation/Offloading For TMAs And Fragile Flaps

David G. Armstrong DPM MD PhD | 3,988 reads | 0 comments | 04/10/2009

Many clinicians have offered means of offloading the posterior diabetic foot both with and without internal fixation. We offer a modification of a post technique described by Saul Trevino, MD.

In this modified technique, we reinforce the posts with a posterior distal to proximal anterior hypotenuse, using the Hoffman II Modular Fixation System (Stryker Orthopaedics) in a patient with end-stage renal disease and a gangrenous forefoot. We were able to correct the patient’s equinovarus position with an Achilles tendon lengthening and external fixation.

Current Concepts In Surgical Offloading Of The Diabetic Foot

Nicholas Todd, DPM, Meagan Jennings, DPM, FACFAS, and Shannon Rush, DPM, FACFAS | 22,119 reads | 0 comments | 04/25/2012

When conservative offloading options have failed and patients with diabetes are at risk of limb loss, one might consider surgical offloading for diabetic foot ulcers. These authors offer their experience with operative techniques for offloading ulcers in areas such as the midfoot, first ray and lesser metatarsals.