title: Downloading plantar foot pressures in the diabetic patient.
abstract: Pressure downloading (offloading) is the most important component in the prevention and treatment of diabetic foot ulcers because peripheral neuropathy is a major contributing factor to more than 90% of all diabetic foot ulcers. Downloading techniques range from the simplest insole, through many types of orthotics and footwear modifications including the ankle-foot orthosis and total contact casting, to surgical procedures. A philosophical difference exists between surgical and nonsurgical approaches, with the patient subjected to the bias of the practitioner. This article explores uniting both surgical and nonsurgical pressure downloading techniques, using a modified Carville Classification System to help the practitioner determine the appropriate method(s) of downloading. By adding a Category 4 to include diabetic persons with foot ulcers or acute Charcot events, a seamless system is obtained to categorize and treat all people with diabetes with pressure downloading recommendations.
authors.affiliation: Calgary Foot Care Clinic, Alberta, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Inlow
authors.forename: T P
authors.initials: TP
authors.lastname: Kalla
authors.forename: J
authors.initials: J
authors.lastname: Rahman
mesh_terms: D017719:Diabetic Foot / Q000145:classification / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011312:Pressure; D012307:Risk Factors; D012720:Severity of Illness Index; D012775:Shoes; D016474:Weight-Bearing