title: When Traditional Offloading is not an Option, Could an External Fixator be a Solution?: A Case Report.
abstract: Offloading is a cornerstone in managing diabetic plantar foot ulcers; however, it often represents one of the most challenging aspects of treatment for clinician and patient alike. The authors present a case of a 61-year-old African American man with type 2 diabetes and a limb-threatening plantar foot ulcer that required aggressive wound and surgical management. Due to the heavy drainage and patient adherence issues, traditional offloading techniques such as total contact cast, DH Pressure Relief Walker (Össur, Foothill Ranch, CA), and wedge shoes, among others, were not viable options. Without offloading, healing will be difficult to achieve and will take a long time, carrying a higher risk of limb loss. The decision was made to apply an Ilizarov circular frame with footplate to facilitate offloading and weight bearing in tandem with negative pressure therapy. Although this is still considered an unusual use of this device, the results were positive and the wound progressed to complete reepithelialization.
authors.affiliation: Jackson Health System, Miami, FL.
authors.forename: Abdulaziz A
authors.initials: AA
authors.lastname: Kimawi
authors.affiliation: School of Podiatry, Barry University, Miami, FL.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Snyder
authors.affiliation: School of Podiatry, Barry University, Miami, FL.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Cala
authors.affiliation: School of Podiatry, Barry University, Miami, FL.
authors.forename: Cherison
authors.initials: C
authors.lastname: Cuffy
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000503:physiopathology / Q000628:therapy*; D016267:External Fixators / Q000706:statistics & numerical data; D005528:Foot / Q000098:blood supply* / Q000503:physiopathology; D006801:Humans; D023821:Limb Salvage / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010349:Patient Compliance; D016896:Treatment Outcome; D016474:Weight-Bearing; D014945:Wound Healing / Q000502:physiology*