Offloading Techniques for Diabetic Foot

Diabetes Mellitus (DM), a serious chronic disease is known to have many complications. Foot complications are one of the most distressing and affect around 15% of all diabetics [1]. By 2008, around 314-382 million were people affected by DM. It has been predicted that the number of diabetics will increase by a double in 2030. With this predicted increase in prevalence of DM, the increase in the complications of DM is likely. Major causes of morbidity and increased financial burden in a diabetic patient are foot ulcers and amputations, which with early detection and management can delay or even prevent the onset of adverse outcomes [2]. Hence, it is recommended that every diabetic patient should have foot evaluation at yearly intervals for risk factors of foot ulcers and amputations that include neuropathy, vasculopathy and deformities [3]. Optimal management entails a multidisciplinary approach for prevention, early evaluation and treatment strategies. The cornerstone of the management are appropriate wound care (and debridement), infection control and pressure reduction. The pathogenesis of neuropathic diabetic foot ulcers involves mechanical trauma due to focal pressure and repetitive moderate stress [4]. This pressure causes maximum damage at the edge of the area of pressure application and has been termed as “edge effect” [5]. Triad of peripheral neuropathy, foot deformity and minor trauma have been found as risk factors in majority of cases of diabetic foot ulcers [6]. Offloading the affected foot has been used as a useful management strategy as it allows for the pressure to be spread over a wider area away from the affected part. A variety of offloading techniques are in use including surgical offloading. The aim of the article is to present the various novel offloading techniques at present and their pros and cons.