Diabetic foot ulcers are painful and can lead to serious complications without proper treatment. A skilled foot doctor will be able to examine your wound and recommend proper offloading techniques for pressure relief, which is essential for treating foot ulcers and preventing potentially serious complications.
At Alliance Foot & Ankle Specialists, our Dallas TX diabetic wound care podiatrists specialize in comprehensive diabetic wound care, including advanced offloading techniques for diabetic pressure relief. Below, our diabetic foot care specialists provide information about various offloading techniques that can be used to treat diabetic foot ulcers effectively.
Why Offloading Is Critical for Diabetic Foot Ulcers
Diabetic foot ulcers develop when prolonged pressure combines with reduced sensation from diabetic neuropathy. These wounds often form on weight-bearing areas of the foot, making healing difficult because each step applies pressure to the wound, reopening it and keeping it from healing.
For diabetic patients, the combination of reduced blood flow and continuous pressure added to a wound makes healing nearly impossible. The relief provided by pressure offloading devices can be an essential component of effective diabetic wound care.
Offloading Devices: Solutions for Diabetic Pressure Relief
Determining the right offloading approach depends on the ulcer's location, your activity level, and your overall health status. The Dallas TX diabetic wound care podiatrists at Alliance Foot & Ankle Specialists will assess you individually to determine the most effective diabetic pressure relief strategy for your specific needs.
Total Contact Casts for Diabetic Foot Ulcer Treatment
A total contact cast (TCC) is custom-molded to conform to the contours of your foot and distribute weight evenly across the entire plantar surface while removing pressure from the ulcerated area. This type of cast significantly reduces pressure from foot ulcer sites, creating an ideal environment for healing.
Total contact casts consist of a specialized inner layer of soft material that protects the skin, followed by a fiberglass or plaster outer shell that provides structure. A specialized walking platform attached to the bottom allows for mobility while maintaining proper offloading. A TCC should only be removed by your foot care specialist, usually weekly.
During cast replacement, your foot doctor will clean the wound area, monitor the healing progress, and adjust the cast as needed before putting it back in order to ensure that the cast continues to provide optimal pressure relief as the swelling in your foot decreases over time. This offloading technique can be highly effective but isn’t suitable for people who have a significant infection, poor circulation, or certain foot deformities.
Removable Cast Walkers for Treating Diabetic Foot Ulcers
For patients who require frequent wound assessment or those with wounds at high risk of infection, RCWs may be preferable to total contact casts because patients can remove the device to care for the wound and clean their foot and the device. The Dallas TX diabetic wound care podiatrist you meet with at one of our Tarrant County offices will consider these factors when recommending the most appropriate device.
A removable cast walker (RCW) has a customizable insole with adjustable cutouts, allowing for targeted pressure relief that adapts as the wound heals. Its features include rocker soles that reduce forefoot pressure during walking and adjustable straps that secure the foot to prevent movement within the device. However, if patients remove them too frequently and leave them off during weight-bearing activities, this can reduce their effectiveness.
Healing Sandals as Offloading Devices for Diabetic Foot Ulcers
Healing sandals typically feature thick, multi-density insoles with cutouts or depressions under ulcer sites. The forefoot area often incorporates a rocker design to reduce pressure during push-off when walking. Adjustable closures accommodate bandages and any foot swelling that may occur throughout the day.
Customized pressure mapping enables healing sandals to address specific pressure points under your foot and any foot deformities you may have. Our experienced podiatrists use computerized pressure analysis to identify exactly where your foot experiences excessive force and design a healing sandal that offloads these precise areas while providing support elsewhere.
Your Dallas TX diabetic wound care specialist may recommend healing sandals for less severe ulcers or as a step-down option to provide continued pressure redistribution after using more restrictive devices. They're also valuable for preventive care in patients with previous ulcers who remain at high risk for recurrence.
Custom Orthotics for Diabetic Foot Ulcers
Unlike offloading techniques that focus on healing active ulcers, custom orthotics are a solution for ongoing diabetic foot ulcer prevention once wounds have healed. They can be an essential part of your long-term diabetic foot care strategy. Our skilled podiatrists design custom orthotics based on detailed assessments of your gait, foot structure, and pressure distribution patterns.
Professionally designed orthotics for diabetic patients feature multiple layers of materials with different densities. Softer materials cushion bony prominences, while firmer supporting elements provide stability and control motion. Additions like metatarsal pads, arch supports, and heel cups address specific biomechanical issues.
It’s best to wear custom orthotics with properly fitting diabetic shoes that provide your feet with extra depth, a seamless interior, and a protective toe box.