CLEAR – A Patient’s Guide to Understanding Offloading Diabetic Foot Ulcers

CLEAR – A Patient’s Guide to Understanding Offloading Diabetic Foot Ulcers

The purpose of this video is to help you understand
the importance of offloading, the use of special footwear, and helping your foot ulcer heal
as quickly as possible. Healing quickly can reduce your risk of developing serious complications.
Key elements of successful healing are: rest, eat a balanced diet and maintain your blood
sugars in a controlled range, wear the device your doctor tells you to wear at all times,
and refraining from smoking. Foot ulcers need rest in order to heal. If you were to break
your leg, your doctor would tell you not to walk on it. It is the same with your foot
ulcer. We rest ulcers by taking off the load, or offloading the ulcer using special casts,
boots, or shoes. [music] The possible complications from a foot ulcer that fails to heal are: development of an infection,
infection spreading to the rest of the body, resulting in hospitalization, amputation at
the foot or leg, or even death. Foot ulcers put you at considerable risk for amputation.
Amputation of part of your foot or leg can lead to changes in your ability to do activities
that are part of your everyday life. It can lead to a decrease in activity, which can
weaken your heart and body, making it difficult to control your diabetes. It can also change
the way you walk or move, potentially causing damage to your other foot and leg. Most importantly,
the challenge of having an amputation can lead to depression and sadness, affecting
how you are able to enjoy your family, friends, and hobbies. Normally, your body’s response
to pain is a sharp reflex that allows you to recoil and prevent further injury. Diabetes
causes changes to the nerves in your feet, and the ability to feel or sense pain. It
robs your body of the protective gift of pain, or the ability to protect itself. This condition
is called neuropathy. People with neuropathy can walk with a stone in their shoe and not
notice it. This could cause an ulcer or blister on their foot. A person with neuropathy does
not know that they have a sore or blister on their foot because they cannot feel it.
By the time you notice the ulcer, it can become very serious. This is why it is important
to check your feet every day for problems. Diabetes can cause the skin on your feet to
become very dry, creating cracks that later become sores or infections. Ask a doctor to
recommend a good moisturizer for your feet and heels. People with diabetes can also have
changes in their leg and foot circulation. This reduces the oxygen, nutrients, and blood
supply to your leg, increasing your risk of getting an ulcer and slowing your ability
to heal. Your doctor may order a test to examine your circulation. Because of these factors,
simple everyday activities such as walking or standing on your injured foot can be harmful
to your healing ulcers. It could worsen the condition or cause infection. If you smoke,
it is important that you talk to your doctor about treatments to stop smoking. Smoking
is a large reason why people develop circulation problems in their legs and feet. Continuing
smoking will slow healing to your ulcer and likely make your circulation worse. The best
way to heal your diabetic ulcers is to take off the load by using special casts, boots,
or shoes. It is important to wear these all the time, even if you are only taking a few
steps. The best way to heal a diabetic foot ulcer is to use a special cast called a total
contact cast. Research shows that more people treated with total contact casts heal than
with other treatments. These include bioengineered tissues, such as growth factors or synthetic
skin substitutes, and negative pressure wound therapy. They also heal faster than with many
of the newer advanced wound-healing technologies. People treated with total contact casts heal
in an average of 42 days.>>DOCTOR: Next I’m going to make this irremovable
by adding on a layer of cohesive bandages. Doctors can also adapt your diabetic walking boot so that you cannot take it off. This
has been shown to be just as effective as a total contact cast. Your doctor may use
a combination of wound and offloading treatments to best heal your ulcer. It may be scary to
think of an ulcer being in a cast where you can’t see it, but the cast helps even out
your weight so the pressure is not just on one part of the foot. Your doctor will change
the cast every few days and even up to once a week if your ulcer is healing well. When
a person breaks their leg, they don’t tell the doctor that the cast is awkward and ugly
or ask for another way to heal their leg. They know that wearing a cast and resting
the bone is the best way to heal it. Likewise, it is important to take the pressure off your
ulcer so that it can heal. Wearing your offloading device for every step will give you the best
chance to heal your ulcer quickly. Your foot ulcer heals at the rate of about one millimeter
per day, or about the width of a dime. Going barefoot is another way to seriously risk
further injury and complications. In the comfort of their own homes, patients either forget
or choose not to wear the offloading device or protective footwear for a few quick steps
around the house or across the room. Don’t do it. Every unprotected step is a day of
healing lost. Going barefoot will slow your healing and make your foot ulcer worse. You
may think that one step here or there without the offloading device will not harm the ulcer.
You may think that it is all right not to wear it for a couple of steps when you get
up to go to the bathroom. What you may not realize is that every step you take without
your offloading device is a day of healing lost. You need to wear your offloading device
all the time. You don’t want to go backwards. You want your ulcer to heal as fast as possible
to avoid or help prevent complications. Proper offloading, using prescribed slippers or shoes
with proper orthopedic inserts, greatly reduces high pressures on the bottom of your foot
that can result in loss of healing, re-ulceration, and complications such as infection. Once
you have had one ulcer, you are at a higher risk for another ulcer. So once your ulcer
has healed, you need to protect the new skin so that it becomes strong, and you need to
protect your foot from new ulcers. Once your ulcer has healed, you may think it is all
right to start wearing regular shoes again or even go barefoot. Unfortunately, even though
your ulcer has healed, you should still never walk barefoot, even at home. By wearing your
diabetic footwear, you protect your foot from high pressures and the danger of injury due
to neuropathy. Injury can result in another ulcer and possible infection, with all the
complications that go with it. Your doctor may prescribe specially fitted shoes or orthotic
inserts to continue to offload your foot and protect it. Remember, diabetes can change
the bones in your foot and create spots of high pressure while you walk. These high pressures
continue to exist even after your ulcer is healed. Continued proper offloading greatly
reduces these pressures on your feet that can cause reinjury. Ask your doctor about
shoes or inserts that are specially fitted to your feet. Insurance will often cover the
cost. Improper choices of footwear to events outside the home environment are a major cause
of foot ulcers reoccurring. Fragile, newly healed skin is not accustomed or equipped
to handle the demands of a social event. It is very tempting to put on those dress shoes
for just a few hours. Don’t do it. Plan to use and wear your diabetic footwear for
all of your activities, including social events. If you have a question about what you can’t
or shouldn’t wear, ask your doctor. Remember, important factors that help heal your ulcer
are: keeping your diabetes in good control, eating a balanced diet, stopping smoking,
rest, and wearing the device the doctor tells you to wear at all times. It is the goal of
your doctor and health care team to help your ulcer heal as quickly as possible to minimize
events such as infection, amputation, and possibly death. To do this, your doctor has
prescribed an offloading device to take off the load from your ulcer. The good news is
that healing is possible for your diabetic foot ulcer. [music]


  1. If you have Type 1 diabetes, You'll be able to radically decrease or even completely remove your dependence on insulin

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