IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Abstract

orthoses to offload and heal a non-plantar foot ulcer without ischemia or uncontrolled infection in a patient with diabetes.The specific modality will depend on the type and location of the foot ulcer.(Weak; Low) Surgical offloading interventions 9. Consider Achilles tendon lengthening (ATL), joint arthroplasty, single or pan metatarsal head resection, or osteotomy to prevent a recurrent foot ulcer when conservative treatment fails in a high-risk patient with diabetes and a plantar forefoot ulcer.(Weak; Low) 10.Consider digital flexor tenotomy to prevent a toe ulcer when conservative treatment fails in a high-risk patient with diabetes, hammertoes, and either a pre-ulcerative sign or an ulcer on the distal toe.(Weak; Low) 11.To heal a neuropathic plantar forefoot ulcer without ischemia or uncontrolled infection in a patient with diabetes, consider ATL, single or pan metatarsal head resection, or joint arthroplasty when conservative treatment fails.(Weak; Low) 12.To heal a distal toe ulcer without ischemia or uncontrolled infection in a patient with diabetes and hammertoes, consider digital flexor tenotomy when conservative treatment fails.(Weak; Low) Other offloading interventions 13.If other forms of biomechanical relief are not available, consider using felted foam in combination with appropriate footwear to offload and heal a neuropathic foot ulcer without ischemia or uncontrolled infection in a patient with diabetes.(Weak; Low) Consideration about side effects/ complicationsIt is important that consideration is given to possible adverse effects of some of the aforementioned interventions, which include the use of non-removable and removable knee-high offloading devices, and all surgical offloading procedures.These possible adverse effects, discussed later, should be discussed with the patient for informed shared decision-making.26