Offloading in ulcer prevention and its relapse

The term “offloading” is generally given to techniques employed in the treatment of
active foot ulceration or immobilisation of acute Charcot neuroarthropathy. It can
equally be used for modalities and strategies for the prevention of new and relapse
ulcers. In this context, perhaps the term “deleterious force management” would
be better suited. Preventing the first ulcer is the ultimate goal of risk screening and
stratification thus understanding the mechanisms for ulceration should direct clinicians
to employ timely and appropriate offloading strategies. The rate of ulcer relapse is very
high with reported rates of 40% in 4–12 months and 70% in 3 years. Managing healed
ulcers is complex and requires considerable understanding and sustained activity.
Central to all of this is active patient involvement and unhindered, easy access to foot
protection teams, as well as adequate resource allocation. It is the authors’ view that
sadly perhaps more focus is placed upon ulcer healing rather than preventing relapse.
This article will briefly explore the area of “offloading” in the prevention of ulceration
and its relapse. When reading this article, it would be useful to bear in mind some of the concepts that were previously discussed in the authors’ article in The Diabetic Foot Journal 19(4), ‘The principles and practicalities of offloading diabetic foot ulcers’.