1. Off-loading; diabetic foot ulcer
Nalaka Gunawansa

4. STAGES OF ULCER DEVELOPMENT

5. STAGES OF ULCER DEVELOPMENT

6. Biomechanics of foot wear
Biomechanical abnormalities are consequence of neuropathy, they lead to abnormal foot pressure
Foot deformity & neuropathy increase the risk of ulcer
Pressure relief is essential for ulcer healing and/or prevention
Frequent inspection of shoes & insoles is mandatory
Appropriate foot wear significantly reduce ulcer recurrence

7. How To Prevent Foot Problems
5 principles
Regular inspection & examination of foot & foot wear
Identification of high risk patient
Education of patient, family & health care providers
Appropriate foot wear
Treatment of non ulcerative pathology

8. SENSORY NEUROPATHY

9. AREAS AT RISK OF ULCERATION

10. NEURO-OSTEOARTHROPATHY(CHARCOT FOOT)

11. Slide 39

12. Slide 36

13. Neuropathy Management =Stop Repetitive Injury Off-load

14. Off-Loading: A Standard of Care
Proper off-loading:
Reduces pressure
Reduces shear
Reduces shock
Transfers weigh from sensitive or painful areas
Corrects or supports flexible deformities
Accommodates fixed deformities
reducing pressure on the diabetic foot ulcer is a vital integral component of effective wound management. Pedorthics is concerned with the design, manufacture, fit and modification of shoes and related foot appliances as prescribed for the reduction of painful or disabling conditions of the foot or limb. Proper off-loading helps reduce pressure, shear, shock, and transfer from sensitive or painful areas. It is important that diabetic patients are properly fitted for off-loading devices because they can often correct or support flexible deformities or accommodate fixed deformities. Joint motion can also be controlled and or limited. 14

15. Off-Loading: A Standard of Care
Off-loading includes:
Rest/elevation
Felt/foam
Multi- podus splint/boot
Removable cast walker/walking boot
Total contact casting (TCC)
Wedge shoe
Surgical shoe with pressure relief insole
Other assistive devices used in addition
Crutches
Wheelchairs
Walkers 15

17. FOOT WEAR

18. PODIATRY

21. Off Loading
Ulcer clinic:
Immediate care

22. Off Loading