Abstract
Diabetic foot ulcers have taught us the role of offloading. All neuropathic foot wounds require offloading to heal. The use of airbed or water bed for pressure sores is again an example of off loading. Foot pressure measurement and preparing proper foot wears is a new science. The whole footwear including insole and outsole requires modifications in many patients. But it should be kept in mind that for foot ulcers to heal best treatment is total contact cast and not the foot wears. To prevent toe deformities after forefoot surgery, specialized footwear with fillers in the insole is essential.
Similarly any wound crossing a joint requires immobilization. Soft tissue also requires plaster to heal like bone. Any wound primarily closed crossing a joint heals better if only rest to the joint is given even with some mobility. But same wound if open requires plaster immobilization to heal. There are many devices for offloading and immobilization.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bauman JH, Girling JP, Brand PW. Plantar pressures and trophic ulceration: An evaluation of footwear. J Bone Joint Surg. 1963;45:652–73.
Ctercteko GC, Dhanendran M, Hutton WC, LeQusne LP, et al. Vertical forces acting on the feet of diabetic patients with neuropathic ulceration. Br J Surg. 1981;68:608.
Armstrong DG, Nguyen HC. Diabetes Care. 2001;24(6):1019–22.
American Diabetes Association. Consensus development conference on diabetic wound care. Diabetes Care. 1999;22:1354–60.
Elftman H. A cinematic study of the distribution of pressure in the human foot. Anat Rec. 1934;59:481.
Harris RI, Beath T. Army foot survey. Ohawa: Report of national research council of Canada; 1947.
Barnes D. A comparative study of two barefoot pressure measuring systems. BMSc thesis, University of Dundee; 1994.
Holmes GB, Willits NH. Practical considerations for the use of the pedobarograph. Foot Ankle. 1991;12(2):105–8.
Wolf L, Stess R, Graf P. Dynamic foot pressure analysis of the diabetic Charcot foot. J Am Pediatr Med Assoc. 1991;81:281.
Rose N, Feiwell LA, Cracchiolo AC. A method for measuring foot pressure using a high resolution, computerized insole sensor: the effect of heel wedges on plantar pressure distribution and center of force. Foot Ankle. 1992;13(5):263–70.
Pitei D, admonds M, Lord M, et al. F SCAN: a new method of in-shoe dynamic measurement of foot pressure. Diabet Med. 1993;7(Suppl, 2):S39.. (abstract)
Diabetes Care. 2008;31(11):2118–9.
Lavery LA, Vela SA, Lavery DC, Quebedaux TL. Reducing dynamic foot pressures in high risk diabetics with foot ulcerations: A comparison of treatments. Diabetes Care. 1996;19:818–21.
Chantelau E, Kushner T, Spraul M. How effective is cushioned therapeutic footwear in protecting diabetic feet? A clinical study. Diabet Med. 1990;7:355–9.
Uccioli L, Faglia E, Monticone G, et al. Manufactured shoes in the prevention of diabetic foot ulcers. Diabetes Care. 1995;18:1376–8.
Mueller MJ, Diamond JE, Sinacore DR, et al. Total contact casting in treatment of diabetic plantar ulcers: Controlled clinical trial. Diabetes Care. 1989;12:384–8.
Zimmy S, Schatz H, Pfohl U. The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers. Diabet Med. 2003;20:622–5.
Ritz G, Kushner D, Friedman S. A successful technique for the treatment of diabetic neurotrophic ulcers. J Am Podiatry Med Assoc. 1992;82:479–81.
Kiewied J. Felt therapy for leprosy patients with an ulcer in a pressure area (letter). Lepr Rev. 1997;68:378–81.
Fleischli JG, Larvery LA, Vela SA, Ashry H, Lavery DC. Comparison of strategies for reducing pressure at the site of neuropathic ulcers. J Am Podiatr Med Assoc. 1997;8:466–472.2q.
Macfarlane DJ, Jensen JL. Factors in diabetic footwear compliance. J Am Podiatr Med Assoc. 2003;93:485–91.
Armstrong DG, Dang C, Nixon BP, Boulton AJ. The hazards of the holiday foot: persons at high risk for diabetic foot ulceration may be more active on holiday. Diabet Med. 2003;20:247–8.
Boulton AJ, Jude EB. Therapeutic footwear in diabetes: the good, the bad, and the ugly? Diabetes Care. 2004;27:1832–3.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Vachhrajani, V., Khakhkhar, P. (2020). Offloading, Footwear and Immobilization. In: Science of Wound Healing and Dressing Materials. Springer, Singapore. https://doi.org/10.1007/978-981-32-9236-9_11
Download citation
DOI: https://doi.org/10.1007/978-981-32-9236-9_11
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-32-9235-2
Online ISBN: 978-981-32-9236-9
eBook Packages: MedicineMedicine (R0)