title: The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report.
abstract: OBJECTIVE
  Published guidelines for effective management of diabetic foot ulcers (DFU) include total contact casting (TCC). The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU) in a complex patient where TCC offloading could not be utilized.
  
  
  METHODS
  The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment included sharp and ultrasound debridement, the use of a silver hydrofiber dressing, edema management via compression therapy, negative pressure wound therapy, offloading via customized 1/4 inch adhesive-backed felt applied to the plantar foot in addition to an offloading boot and use of a wheelchair, patient education regarding diabetes management, and the application of a bilayered living skin-equivalent biologic dressing.
  
  
  RESULTS
  At 15 weeks the wound was closed and the patient was transitioned into diabetic footwear.
  
  
  CONCLUSIONS
  The felt offloading was a beneficial alternative to TCC. The patient's longer than average healing rate may have been complicated by the duration of her wound, her 41 year history of diabetes, and the fact that gold standard offloading (TCC) was not able to be used. Further research is needed regarding the use of felt for offloading, such as application technique for wounds on different areas of the foot, comparison of different types of felt, and the use of felt in conjunction with various offloading devices.
authors.affiliation: The Wound Healing Center of Osceola Regional Medical Center, Kissimmee, FL 34741, USA. melodieblakely@gmail.com.
authors.forename: Melodie
authors.initials: M
authors.lastname: Blakely
keywords: best practice; diabetes; diabetic ulcer; felt offloading; multi-disciplinary; offloading; total contact cast; unweighting; wound; wound care