Overview
Reviewed by Dr. Jeff Stone
Off-loading refers to technique that relieves pressure from the surfaces of the foot most affected by diabetic foot ulcers . Pressure relief is a crucial aspect of diabetic foot management. When a foot ulcer is present patients should remain off the foot entirely. However, since foot ulcers can take weeks to heal, and patients often need to be ambulatory during that time, pressure reduction devices are necessary.
Many pressure reduction devices exist for ambulatory patients. They range from types of casts to redistribute weight in the foot, to walkers and crutches that relieve weight from the foot entirely. A clinician will determine the device most appropriate for a patient, depending upon their level of activity and severity of the ulcer.
Detailed Description
Total Contact Casts, or TCC, are minimally padded, well-molded plaster casts. TCC uniformly decrease pressure across the entire foot. Patients maintain the ability to walk in the casts, but at the same time, are able to rest the foot. They also control swelling and protect the foot from contamination and additional trauma. Patients are unable to remove TCC, so they have no choice but to continue to utilize the device.
TCC are disadvantageous in some ways. For one thing, because patients cannot remove them, they are unable to examine the wound on a daily basis. Because of the inability to monitor the wound, they are not appropriate for infected wounds. Additionally, TCC application must be correct; any improper cast application may go undetected as a result of peripheral neuropathy, and has the potential to lead to further ulceration. Finally, TCC are cumbersome, unattractive, and heavy. Patients may find them difficult for sleeping, and have difficulty bathing without getting the cast wet.
Removable walking casts and half-shoes are two types of off-the-shelf devices, meaning that they are not molded specifically for each patient’s foot. These devices are based on the devices that stabilize a foot, but are modified to provide pressure relief for diabetic foot ulcers. The advantages of removable walking casts and half shoes are that patients can remove them to examine their feet on a consistent basis, as well as apply topical antibiotics, or growth factors. Patients can also remove them for sleeping or bathing, and use the casts on infected wounds. The drawback of removable devices is patient compliance. If a doctor recommends that a patient use pressure reduction footwear, it is important that the patient refrains from walking without the off-loading device.
Last updated: 19-May-04
