Off-loading the diabetic foot for ulcer prevention and healing

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Off-loading the diabetic foot for ulcer prevention and healing Peter R. Cavanagh, PhD, DSc, Sicco A. Bus, PhD Journal of Vascular Surgery Volume 52, Issue 3, Pages 37S-43S (September 2010) DOI: 10.1016/j.jvs.2010.06.007 Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

Fig 1 A, Peak plantar pressure distribution shown for the right foot during barefoot walking. The highest pressure experienced by each area of the foot through the support phase is shown on the diagram. The pressure distribution inside the shoe of the same patient is shown while (B) a flat cushioning insole and (C) a custom-made insole are being used. The red and purple colors represent the areas with the highest measured pressure. Note the superior off-loading of high-pressure regions identified during barefoot walking (C) in the custom insole compared with (B) the insole. Journal of Vascular Surgery 2010 52, 37S-43SDOI: (10.1016/j.jvs.2010.06.007) Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

Fig 2 The off-loading capacity of different modalities used for the prevention and treatment of diabetic plantar foot ulcers is expressed as percentage of peak pressure reduction at the first metatarsal head region compared with a control condition. The lighter bars show the range in measured peak pressure reduction over different studies. Journal of Vascular Surgery 2010 52, 37S-43SDOI: (10.1016/j.jvs.2010.06.007) Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

Fig 3 Histogram showing the proportion of healed ulcers expressed as a percentage (black bars) and time to healing expressed as a number of days (dark gray bars) for different off-loading modalities used to treat noncomplicated neuropathic plantar foot ulcers in diabetic patients. The light gray bars show the range found in different studies. The number of studies on which the bars showing percentage healing are based is also indicated. Journal of Vascular Surgery 2010 52, 37S-43SDOI: (10.1016/j.jvs.2010.06.007) Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions