An Alternative Method of Offloading the Neuropathic Foot Ulcer

In 2010, the Center for Disease Control estimated 23.6 million people in the United States (7.8% of the total population) have diabetes mellitus (DM). Of these, 5.7 million have undiagnosed diabetes.  DM is associated with multiple complications including peripheral polyneuropathies.  Neuropathy affects approximately 60% of all patients with DM.  Of the 60%, fifteen per cent will develop foot ulcer.  More than 80% of limb amputations in diabetics are the result of a neuropathic foot ulcer.

The primary goals for managing and healing a diabetic foot ulcer are (1) to control or eliminate causative factors, (2) provide a systemic support of the patient to reduce existing and potential cofactors and (3) to maintain a physiologic local wound environment.  Interventions that reduce psychological and physiologic distress also play a major role in wound healing and limb preservation.

 This case study reflects a synthesis of holistic patient care, principles of wound healing, basic foot anatomy and physiology along with evidence-based competent creativity that contisitues the essence of Wound Nursing practice.  The patient highlighted in the article presented initially to the ED with symptoms of sepsis.  The patients’ lab and x-ray reports supported the diagnosis of Charcot’s Deformity with an open wound that did not include osteomyelitis.  Total contact casting was not an option.  Total nonweight bearing was not a realistic option for this patient due to his living environment.  A pressure relieving dressing was designed to redistribute pressure on the foot as well as to severely restrict ankle mobility.  This method was successful and was subsequently duplicated  with other patients.  Out of ten patient trials, there was a seventy per cent success rate; i.e. patients healed and were able to return to wearing prescription orthotics.  Of the three that did not respond, two had to have osteomoties to facilitate wound closure.