Offloading for Diabetic Foot Ulcers: How to Urge Patient Compliance

Ten years ago, in 2011, the authors of “Lower extremity amputations — a review of global variability in incidence” stated that the incidence of diabetes mellitus had reached “pandemic status.” In fact, one in ten Americans has diabetes, according to the most recent data report, and one in three has pre-diabetes.

High incidence of diabetes means higher numbers of diabetic foot ulcers, a complication experienced in an estimated 15% of the patient population during their lifetime. DFUs can lead to a cascade of poor outcomes and are associated with an enormous cost burden on the healthcare system.

Pressure relief is considered key to healing plantar DFUs, yet DFU patients may not adhere to their doctor’s recommended offloading protocol due to the potential disruption to everyday activities such as bathing, driving and sleeping.

A 2003 study by David Armstrong found that only 30% of patients wore an offloading device for over half of their daily steps. Among those patients, the average rate of compliance was only 60% of daily steps.

In a consensus statement and practical recommendations published in the Journal of the American Podiatric Medical Association, total contact casting (TCC) is the preferred method for offloading diabetic plantar foot ulcers. “Comparing TCC with removable devices, TCC has been found to be more successful in healing outcomes because it enforces adherence by virtue of irremovability,” they write.

Here are some compelling reasons for offloading to share with your patients:

DFUs may be as deadly as some cancers.

A single, non-healing wound on the bottom of their foot may not inspire patients to take urgent attention towards medical intervention. Yet outcome numbers may underscore the seriousness of these wounds.

One study found that 5% of people with a new DFU died within 12 months of their first physician visit for an ulcer and 42.2% with foot ulcers died within 5 years. These mortality rates are as high as aggressive types of cancer, such as cervical cancer at 34% and colorectal cancer at 35%.

When you save your leg, you may save your life.

A serious complication of DFUs are lower limb amputations. In fact, approximately 85% of all amputations performed in diabetic patients are preceded by a DFU. Several studies confirm the high mortality rates in diabetic patients after non-traumatic lower extremity amputation.

For example, a systematic review of the 5-year mortality after nontraumatic major amputation published in the Journal of Foot and Ankle Surgery found that mortality after below-the-knee amputation ranged from 40% to 82%.

Clinical data shows that offloading, when adhered to correctly, aids healing.

An offloading cast such as TCC-EZ® Total Contact Cast has been shown to reduce amputation rates by more than half within 1 year.

Offloading won’t last forever.

TCC has demonstrated ulcer closure rates of 88% of DFUs in 43 days.

Contact your sales rep to get a copy of the TCC-EZ® Total Contact Cast Patient Kit.

Patient Safety Information:

The application and removal of TCC-EZ should be supervised by a physician or a licensed health care provider.

Patients should contact your doctor immediately if any of the following occur while wearing a TCC-EZ:

• • The cast is “loose,” “rubbing,” “pistoning” or “sliding”
  • The cast is causing pain
  • Patients develop fever, chills, nausea, or vomiting
  • The cast gets wet
  • If the patient or healthcare provider has other cause for concern, such as claustrophobia

Warning: Inappropriate use or removal of the TCC-EZ could result in injury.

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