Offloading, Footwear and Immobilization
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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.
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