Abstract
Diabetes mellitus affects over 400 million people worldwide and this number is expected to double in the next 25 years. For people living with diabetes, approximately 25% of them will develop a diabetic foot ulcer and subsequently a 40% risk of lower extremity amputation. The harsh reality is that a large number of ulcerations that lead to amputation can be prevented. Offloading, whether it be by conservative or surgical methods, is paramount in both prevention and treatment of diabetic foot ulcerations. Understanding the etiology and biomechanics of each patient will guide the practitioner in choosing the appropriate offloading technique to use.
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References
International Diabetes Federation. IDF diabetes atlas. 9th edn. 2019. p. 14–25.
Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A. Health economics of diabetic foot ulcer and recent trends to accelerate treatment. Foot. 2022;52:101909. https://doi.org/10.1016/j.foot.2022.101909.
Blume P, Stephanie W. Updating the diabetic foot treatment algorithm: recommendations on treatment using advanced medicine and therapies. 2017;30(2):29–35.
Cavanagh P, Bus S. Off-loading the diabetic foot for ulcer prevention and healing. 2010;52(3):37–43.
Baker N, Osman I. The principles and practicalities of offloading diabetic foot ulcers. 2016;19(4):172–81.
Kim P. Biomechanics of the diabetic foot: consideration in limb salvage. 2013;2(3):107–11.
Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. 2000;23:606.
Dardari D. An overview of Charcot’s neuroarthropathy. J Clin Transl Endocrinol. 2020;22:100239.
Potter J, Potter MJ. Effect of callus removal on peak plantar pressures. Foot. 2000;10(1):23–6.
Veves A, Murray HJ, Young MJ, Boulton AJ. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992;35:660.
Mrdjenovich D. Off-loading practices for the wounded foot: concepts and choices. J Am Col Certif Wound Spec. 2010;2(4):73–8.
Armstrong DG, Athanasiou KA. The edge effect: how and why wounds grow in size and depth. Clin Podiatr Med Surg. 1998;15(1):105–8.
McCartan BL, Rosenblum BI. Offloading of the diabetic foot: orthotic and pedorthic strategies. Clin Podiatr Med Surg. 2014;31:71–88.
Albert S, Rinouie C. Effect of custom orthotics on pressure distribution in the pronated diabetic foot. J Foot Ankle Surg. 1994;33:598–604.
Lanez-Sharma R. Diabetic shoes: why you need them. https://www.ankle-footspecialist.com/blog/diabetic-shoes-why-you-need-them. Accessed 21 March 2022.
Tejada A. The difference between diabetic shoes and regular shoes. 2019. https://www.orthofeet.com/blogs/news/the-difference-between-diabetic-shoes-and-regular-shoes. Accessed 22 March 2022.
Gutekunst DJ, Hastings MK, Bohnert KL, Strube MJ, Sinacore DR. Removable cast walker boots yield greater forefoot off-loading than total contact casts. Clin Biomech. 2011;26(6):649–54.
Pollo FE, Brodsky JW, Crenshaw SJ, Kirksey C. Plantar pressures in fiberglass total contact casts vs a new diabetic walking boot. Foot Ankle Int. 2003;24(1):1–5.
Ababneh A, Finlayson K, Edwards H, Lazzarini PA. Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers. BMJ Open Diabetes Res Care. 2022;10:e002640.
Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Haarkless LB. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24(6):1019–22.
Rogers LC, Hanft J. Point-counterpoint: is total contact casting better than the CAM Walker Boot for plantar diabetic wounds? 2019. https://www.hmpgloballearningnetwork.com/site/podiatry/point-counterpoint-total-contact-casting-better-cam-walker-boot-plantar-diabetic-wounds. Accessed 22 March 2022.
Messenger G, Masoetsa R, Hussain I. A narrative review of the benefits and risks of total contact casts in the management of diabetic foot ulcers. J Am Coll Clin Wound Spec. 2017;9(1–3):19–23.
Griffiths DA, Kaminski MR. Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study. J Foot Ankle Res. 2021;14(1):44.
Elattar O, Smith T, Ferguson A, Farber D, Wapner K. Uses of braces and orthotics for conservative management of foot and ankle disorders. Foot Ankle Orthop. 2018;3(3).
Sarmiento A. A functional below-the-knee cast for tibial fractures. J Bone Joint Surg Am. 1967;49:855–75.
Alimerzaloo F, Kashani RV, Saeedi H, Farzi M, Fallahian N. Patellar tendon bearing brace: combined effect of heel clearance and ankle status on foot plantar pressure. Prosthet Orthot Int. 2014;38(1):34–8.
Tanaka H, Goto NT, Inoue A. The effect of the patellar tendon-bracing cast on loading. J Bone Joint Surg Br. 2000;82(2):228–32.
Armstrong DG, Frykberg RG. Classifying diabetic foot surgery: toward a rational definition. Diabet Med. 2003;20:329–31.
Armstrong DG, Stacpoole-Shea S, Nguyen H, Harkless LB. Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J Bone Joint Surg Am. 1999;81:535–8.
Mueller M, Sinacore DR, Hastings MK, Strube MJ, Johnson JE. Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am. 2003;85(8):1436–45.
Tamir E, Tamir J, Beer Y, Kosashvili Y, Finestone AS. Resection arthroplasty for resistant ulcers underlying the Hallux in insensate diabetics. Foot Ankle Int. 2015;36(8):969–75.
Tamir E, Finestone AS, Avisar E, Agar G. Mini-invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers. J Orthop Surg Res. 2016;11:78.
Ramanujam CL, Facaros Z, Zgonis T. Surgical off-loading external fixation and plastic reconstruction of the foot and ankle. 2016. https://musculoskeletalkey.com/surgical-off-loading-external-fixation-and-plastic-reconstruction-of-the-foot-and-ankle/. Accessed 26 March 2022.
Lobst CA, Liu RW. A systematic review of incidence of pin track infections associated with external fixation. J limb lengthening reconstr. 2016;2(1):6–16.
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Zarick, C.S., Bertram, K.D., Milisits, T.F. (2023). The Science and Utility of Offloading the Diabetic Foot. In: Attinger, C.E., Steinberg, J.S. (eds) Functional Limb Salvage. Springer, Cham. https://doi.org/10.1007/978-3-031-27725-2_7
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DOI: https://doi.org/10.1007/978-3-031-27725-2_7
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