OFF loading

Question 1

What is the benefit of offloading?

Answer 1

-Reduces healing time
-Reduces risk of infection
-reduce risk of further complication
- better outcome and quality of life

Question 2

What sort of offloading approach is required for neuropathic ulcer?

Answer 2

-none removable knee high offloading device. either a total contact cast

Question 3

What offloading regime is the gold standard for plantar foot ulcer?

Answer 3

Total contact cast

Question 4

What are the contraindicaiton of TTC?

Answer 4

in presence of PAD, infection or fluctuant oedema

Question 5

What are none removable offloading device?

Answer 5

TCC-EZ and instance TCC
Time effective, costly, not Custom

Question 6

What are removable offloading devices?

Answer 6

• are used when none removable not tolerated
  Air cast walker:
  -Pneumatic walker
• Air cells provie compression and stabilisation
  -Large weigh bearing surface area
  -Remove same amount of plantar pressure as a total contact cast
  -Used for plantar ulcer and charcot immobilisation
  -Rocker sole aid with propulsion
  -Allows for dressing changes

Question 7

None pneumatic walkers:

Answer 7

-Reduced support compared to aircast walker
-Useful in the presence of pad when aiscast walker are contraindicated
-large wieght bearing surface area
-rocker sole aids with propulsion

Question 8

What are the treatment options when conservative and offloading fails for the healing of plantar ulcers?

Answer 8

-Achillis tendon lengthening
, met head resection
-joint arthroplasty

Question 9

What are the offlaoding option after healing of plantar ulcer?hear

Answer 9

• Custom footwear and orthosis
  which accommodate foot deformity
  -reduce the shearing force
• Wheelchairs are difficult to use in the unmodified home
  -orthosis reducing peak plantar pressure and prevention of ulcer recurrence

Question 10

What are the footwear options for ulcers that are not involved in WB areas?

Answer 10

Shear comfort and sheepskin boot for dorsal digital ulcers
Consider falls risk
Also post op shoes for none plantar ulcer- accommodate large dressing

Question 11

What are the device to offload the posterior heel?

Answer 11

-pressure relieving ankle foot orthotic (PRAFO)
Offload posterior heel
There is falls risk

Question 12

What is the offloading device for heel ulceration?

Answer 12

HERBST cradle
used none weight bearing only

Question 13

Patient utilization of the device is affected by?

Answer 13

-Patient understanding of their condition
education provided
Social consideration
Work environment
Discuss TCC healing versus major amputation