offloading diabetic foot ulcers andrew bernhard class of 2013
TRANSCRIPT
Chronic wound caused by neuropathy and pressure
Sensory, motor, and autonomic neuropathies possible
Often seen over boney prominences or in areas of increased pressure, sometimes due to shoe pressure
Generally painless Hyperkeratotic rim with moist base
Diabetic Foot Ulcers
Wagner System – Grades 0–6, No open lesion – gangrene
UTHS – Two parts based on grade (0-3) and stage (A-D)
PEDIS – Perfusion, Extent, Depth, Infection, Sensation
NPUAP – Most common classification, Stages 1-4
Staging of Ulcers
Aggressive debridement is key to helping wound
Surgical debridement, or incision and drainage, are often required
Correcting blood sugar correlates with decreased ulcer incidence
Offloading the foot will also decrease recurrence and speed up recovery
Ulcer Treatment
Various devices are available to offload the foot
The gold standard is the Total Contact Cast Removable Cast Walkers are also a
possibility Diabetic shoes are generally good for healed
ulcers
Offloading of Diabetic Ulcers
Gold standard for ulcer treatment Transfer weight of lower extremity
from foot to lower leg, by 1/3 45% reduction in forefoot loading Contraindicated in heel ulcers, infection,
poor skin quality, arterial insufficiency
Changed weekly for 6 weeks Very rarely used (1.7% of ulcers)
Total Contact Cast
Alternative to Total Contact Cast Cheaper More attractive to patient Better visibility of wound Poor patient compliance, due
to removability
Removable Cast Walkers
More used to control ankle motion Not necessarily designed for ulcer treatment Can provide offloading, similar to an RCW or
TCC Still removable, so compliance is decreased
CAM Walker
Good choice – Charcot Restraint Orthotic Walker
Fully padded interior with hard, immobile exterior
Covers entire foot and lower leg Patient needs to acclimate to the boot, one
hour at a time
CROW Walker
Orthowedge – unloads forefoot completely Heelwedge – good for unloading heel Medsurg / Surgical Shoe Wound Care Shoe System
Darco products
Other options
Wu, Stephanie, et. al. “Use of Pressure Offloading Devices in Diabetic Foot Ulcers: Do we practice what we preach?” Diabetes Care. 2008 November; 31(11): 2118–2119
Kushner, Donald. “The Diabetic Foot.” OCPM Lecture Cavanagh, Peter, et. al. “Treatment for diabetic foot
ulcer” Lancet. 2005; 366: 1725–35 Darco Products -
http://www.darcointernational.com/off-loading-wound-care
References