Management of Diabetic Foot Ulcers: Offloading and Debridement

  • Chia-Ding Shih
  • Laura Shin
  • David G. Armstrong
Part of the Updates in Clinical Dermatology book series (UCD)


Diabetic foot ulcer and its complications are common, costly, and challenging. Diabetic peripheral neuropathy, foot deformity, and trauma are three contributors to diabetic foot ulcerations. Evaluation of diabetic foot ulcerations includes four main systems: vascular status, neurological findings, dermatological manifestations, and musculoskeletal presentations. Local wound care for noninfected diabetic foot ulcers requires assessment, debridement, and most importantly offloading. A wide array of offloading modalities are currently available including removable and nonremovable. For many medically stable patients, prophylactic reconstructive surgery has shown to extend ulcer-free days and provide excellent long-term outcome. By understanding the etiology of diabetic foot ulcer and the disease process, local wound care and offloading are imperative to ensure wound healing and are the initial steps to prevent major amputations. To comprehensively manage this population, a multidisciplinary team approach is necessary to effectively reduce major amputations.


Offloading Wound healing Debridement Total contact cast Diabetic foot Peripheral neuropathy Biomechanics Deformity Charcot neuroarthropathy 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Chia-Ding Shih
    • 1
  • Laura Shin
    • 2
  • David G. Armstrong
    • 3
  1. 1.California School of Podiatric Medicine at Samuel Merritt UniversityDepartment of Podiatric MedicineOaklandUSA
  2. 2.Keck Medicine of the University of Southern CaliforniaDepartment of SurgeryLos AngelesUSA
  3. 3.University of Southern CaliforniaDepartment of SurgeryLos AngelesUSA

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