Geiss L Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult US population. Diabetes Care. 2019; 42:(1)50-54

Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. New Eng J Med. 2017; 376:(24)2367-2375

Armstrong DG, Nguyen HC, Lavery LA Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001; 24:(6)1019-1022

Piaggesi A, Viacava P, Rizzo L Semiquantitative analysis of the histopathological features of the neuropathic foot ulcer: effects of pressure relief. Diabetes Care. 2003; 26:(11)3123-3128

Penny Harry Comparison of two pixelated insoles using in-shoe pressure sensors to determine percent offloading: case studies. J Wound Care. 2020; 29:(2)S18-S26

Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound care?. Wound Repair Regen. 2010; 18:(2)

Wu SC, Jensen JL, Weber AK. Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?. Diabetes Care. 2008; 31:(11)2118-2119

McGuire J, Sebag J Reexamining the gold standard for offloading of DFUs. Podiatry Today. 2017; 30:(3)60-64

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Wound healing 101 is missing: what is driving poor practice in diabetic foot ulcer wound care?

02 May 2021
Volume 5 · Issue 2

Caroline Fife

There is an epidemic of diabetes-related lower extremity amputations (LEA) occurring in the US, and the global situation is likely similar. After declining 43% between 2000 and 2009, the age adjusted rate of LEAs in the U.S. increased by 62% between 2009 and 2015.1

Many, if not most of these amputations, result from complications of plantar diabetic foot ulcers (DFUs), which are among the more challenging clinical scenarios faced by wound care providers. Most of these wounds become infected, and about 20% of DFUs will necessitate an amputation.2 Further complicating this healthcare crisis is that the most financially vulnerable members of society, particularly in communities of color, disproportionately bear the brunt of the morbidity and mortality.3

Undoubtedly, multiple factors are contributing to the increase in amputations, but we cannot ignore the probability that gaps in the quality of wound care are contributing to this crisis. As a wound care practitioner, what is deeply frustrating is knowing that much of the morbidity and mortality associated with DFUs could be avoided with the use of simple, inexpensive and straightforward offloading therapy. Offloading of vulnerable areas of the plantar surface is about as basic as it gets when it comes to plantar DFU wound care. It has been demonstrated time and time again that most plantar diabetic foot ulcers can be successfully healed when patients adhere to using appropriate and effective offloading devices.4,5,6

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