Exploring Simple but Effective Offload Modality for Plantar Diabetic Foot Ulcer

Exploring Simple but Effective Offload Modality for Plantar Diabetic Foot Ulcer

 

What was the problem?

Every 30 seconds a lower limb is lost due to Diabetes Mellitus (DM) in the world (www.idf. org/home).  15% patients with DM are at risk for foot ulcers (DFUs); 50% of non-traumatic amputations were related to DFUs; mortality rate of DFU amputations is 50% (Armstrong et al 2007; Statistic Canada, 2010).

Although Total Contact Cast (TCC) is Gold Standard with 90% healing rate, various barriers results in only 2% Wound Clinics utilized TCC (Fife et al 2010; Greenagh 2012); lesser effective offloading devices are being used (Bus, 2012; Cavanagh & Bus, 2011; Wu et al 2008).

How did the author(s) solve it?

TCC has straight selection criteria.  When TCC is contraindicated, when patient refuses, and/or when deep wound infection is not controlled yet, the author employed TCC Poor Man, the application of a ¼” adhesive felt with a horse-shoe shape hole to offload without immobilize the plantar surface DFU and the periwound skin (Zimmy et al 20101).

What was discovered?

The author applied the adhesive felted foam in a way slightly different than Zimmy et al (2001) to address the periwound skin damage related to exudate management.  This way of TCC Poor Man application with the use of a ¼ adhesive felt felted foam appeared to be useful to reduce the peak plantar pressures at the site of ulceration.  With the application of the TCC Poor Man, patients with plantar DFU have their ulcers closed in weeks. 

What can be learned from the experience?

Effective off-load is critical for healing DFUs.  The application of TCC Poor Man is of potential benefit in healing DFUs with Wagner classifications of Class 0 to class 3.