What are the IWGDF guidelines on pressure offloading in the treatment of diabetic foot ulcers?

Updated: Oct 15, 2020
  • Author: Tanzim Khan, DPM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The aforementioned IWGDF practical guidelines state the following with regard to pressure offloading in ulcer treatment [35] :

  • For patients with a neuropathic plantar ulcer, a nonremovable knee-high offloading device—ie, either a total contact cast (TCC) or a removable walker that is rendered irremovable by the provider who fits the device—is the preferred offloading treatment
  • In patients who cannot tolerate a nonremovable, knee-high offloading device, or if such a device is contraindicated, a removable version can be considered; should a removable device be contraindicated or if it cannot be tolerated, an ankle-high offloading device can be considered; patients must be educated with regard to the benefits of adherence to removable device use
  • In the absence of other forms of biomechanical relief, felted foam, in combination with appropriate footwear, can be considered
  • While offloading remains important in the presence of infection or ischemia, greater caution is necessary
  • Nonplantar foot ulcers, depending on their type and location, should be addressed with a removable, ankle-high offloading device, footwear modifications, toe spacers, or orthoses

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