Offloading Diabetic Foot Ulcers Q&A
In anticipation of the publication and current presales of the Wound Care Certification Study Guide, Second Edition, we offer a sneak peek of several questions and answers from“Chapter 20: Offloading Diabetic Foot Ulcers – Orthotics” by Elias R. Cheleuitte, DPM, FACFAS.
1. Which is a common etiology of diabetic foot ulcerations?
a.) repetitive microtrauma
b.) peripheral neuropathy
c.) areas of high pressure
d.) all of the above
2. Which modality is best suited for forefoot plantar diabetic ulceration?
a.) healing sandal
b.) cam walker
c.) integrated prosthetic and orthotic system (IPOS)
d.) PO shoe
3. Which is the highest risk factor for diabetic foot ulceration?
a.) poor glycemic control
b.) increased plantar pressure
c.) loss of plantar sensation
4. Which modality is considered the gold standard in offloading diabetic foot ulcerations?
a.) total contact cast
b.) healing sandal
c.) CROW device
d.) PO shoe
5. All of the following factors require consideration before choosing an offloading modality except:
a.) location of ulceration
b.) patient functional capabilities
c.) patient insulin dependency
d.) vascular studies
- d) A common etiology of diabetic foot ulcerations is usually repetitive microtrauma at areas of high pressure in patients with peripheral neuropathy.
- c) An integrated prosthetic and orthotic system (IPOS) is best suited to offload diabetic forefoot ulceration. The healing sandal and cam walker are also used to offload diabetic ulcers; however, IPOS is best suited for offloading diabetic forefoot ulcers. The PO shoe is not able to offload forefoot ulcers.
- c) Loss of protective sensation in the plantar foot (neuropathy) is the highest risk factor for the diabetic foot ulcer.
- a) Total contact casting (TCC) is considered the gold standard for offloading diabetic foot ulcers.
- c) Before choosing an offloading device, it is important to look at the location of the ulcer, the functional capabilities of the patient, and the patient’s vascular status. Insulin dependency is not a factor in the choice of an offloading device.
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- Snyder Frykberg RG, Rogers LC, Applewhite Bell Bohn G, Fife CE, Jensen Wilcox,management of diabetic foot ulcers through optimal off-loading; building consensus guidelines and practical recommendations to improve outcomes. J Am Podiatr Med Assoc. 2014; 104(6):555-67.
- Elias C, DPM. Offloading diabetic foot wounds/ orthotics. Shah JB, Sheffield PJ, Fife CE, eds, Wound Care Certification Study Guide, North Palm Beach, Fla: Best Publishing Company; 2016.