Offloading Intervention

James McGuire's picture
View of Pressure Points on a Foot

by James McGuire, DPM, PT, CPed, FAPWH

According to the American Diabetes Association, there are 29.1 million Americans with diabetes, 8.1 million of whom are walking around undiagnosed.1 This number is dwarfed by the 86 million Americans who have been classified as having prediabetes and who are at risk for developing diabetes in the near future. Each year, 1.7 million Americans age 20 years or older — 4,660 per day, or one every 19 seconds — are added to the rolls and begin a slow but steady acquisition of the devastating complications of the disease.

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Laurie Swezey's picture
total contact casting

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Total contact casting (TCC) is considered to be the 'gold standard' in the treatment of diabetic foot ulcers. Although TCC is often very successful in healing diabetic foot ulcers, this treatment modality is not used as often as it could be.

Mark Hinkes's picture
leg bones

by Dr. Mark Hinkes, DPM

Unequal limb length (ULL) is a clinical problem that is more common than most clinicians realize and is one for which most patients are rarely evaluated. Common problems associated with unequal limb length include instability in gait, falling, low back pain, sciatica, joint pain, IT Band Syndrome, chronic muscle strain, tendonitis, and failure of diabetic foot wounds to heal.

Temple University School of Podiatric Medicine's picture

by Rizwan Tai and James McGuire DPM, PT, CPed, FAPWHc

According to Centers for Disease Control and Prevention (CDC), the number of adults between the ages of 18-79 with newly diagnosed diabetes has more than tripled in the last 30 years. Foot ulcers are a major complication of uncontrolled diabetes, and 25% of the patients will be affected with foot ulcers in their lifetime, the majority of which lead to lower extremity amputations.

Temple University School of Podiatric Medicine's picture

by Tedman L. Tan and James McGuire DPM, PT, CPed, FAPWHc

The management of diabetic foot ulcers is becoming an increasingly significant concern with the growing population of patients with diabetes in the United States. Most amputations involving the lower extremity in patients with diabetes are preceded by foot ulcers, and in turn, lower extremity amputations are associated with a high 5-year mortality rate at around 45% among individuals with diabetes.1 Therefore, diabetic foot ulcers require special attention due to the possible life-threatening complications associated with such wounds.

Margaret Heale's picture

Perspective of Nursing Care from Past to Future by Matron Marley

by Margaret Heale, RN, MSc, CWOCN

Another day at Rose Cottage is over and I am remembering some events and pondering as I wait for my granddaughter to finish work and drop me off home. I have been volunteering here a while now and am getting used to being in a position of watching, listening and not having to react to everything as I am just an outsider helping out. I was a matron though, and the patterns within my brain are such that I must at least ponder at where we are, where we came from and where we are heading. ‘Ahhh,’ you are thinking she is going to bemoan modern nursing and call for a return to the good old days, well you’d be wrong. I am not sure it was all so good and with new blood, new technologies and modern versions of Flo, we will see our Scutari change and develop into a new and exciting place. Well you will, I will join my fellows here at some point and allow you to care and listen.

Aletha Tippett MD's picture

by Aletha Tippett MD

The great medical pioneer, Dr. Paul Brand, was right when he said it's not about medicine, it's about mechanics. Think of the ulcers you are asked to see and treat. I hope the first question you ask about any wound is "how did this get here?" If the mechanics of a wound are not addressed, the medicine will not be successful.

Laurie Swezey's picture

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Pressure mapping has traditionally been used by physiotherapists, occupational therapists, chiropractors, orthotists and other health professionals to determine where pressure might become an issue for a patient and how to redistribute skin-damaging pressure for the prevention of pressure ulcers.

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James McGuire's picture

James McGuire DPM, PT, CPed, FAPWCA

It is essential that the various offloading devices available to the wound care professional are applied appropriately to redistribute destructive forces that develop in the diabetic or neuropathic foot during standing and ambulation.1,2 The 6 "W" approach was first introduced in an article in 20063 to help practitioners better understand the biomechanical risk profile of patients at risk for ulceration so that they could better choose between the various offloading interventions available for their everyday footwear.