Advertisement
Perspectives

Diabetes-related foot ulcers: the role of pressure offloading

Vanessa Nube

Figures

© devrimb/istockphoto.com
© devrimb/istockphoto.com

Abstract

Ulcers will not heal if subjected to repetitive trauma. Individualised wound-management plans must prioritise identification and management of infection, ischaemia and trauma. Prevention and management of diabetes-related foot ulcers also relies on reducing trauma to the foot, particularly through pressure offloading.

Key Points

  • Most foot ulcers are related to neuropathy, which reduces sensation in the feet and hence patients will be unaware of the harm they do by continuing to walk on an ulcer.
  • It is not generally recommended that a patient continues to wear their regular footwear when they have an active foot ulcer.
  • Treatment for foot ulcers comprises individualised strategies including reducing walking, using a pressure-offloading device and gaining a commitment from the patient to wear the device.
  • If the wound is on the plantar aspect (sole) of the foot, a total contact cast or removable cast walker (ideally rendered irremovable), if they can be worn safely, are used in conjunction with an insole.
  • Most podiatrists have some expertise in treating foot ulcers but it is recommended they enlist the care of a specialised multidisciplinary high-risk foot service if it is available at the local public hospital.
  • Ulcer recurrence is common; long-term foot protection including appropriate footwear, regular treatment by a podiatrist, ongoing foot checks and education is needed.

Figures

© devrimb/istockphoto.com
© devrimb/istockphoto.com