Title: Newer offloading technics at Foot wear can heal difficult Heel DFU keeping Patient ambulatory. Author: Dr. Sunil V.Kari., Diabetic Foot Surgeon. Instutute: Sou.Mandakini Memorial Hospital, HUBLI, Karnataka,INDIA. Purpose: Heel DFU is a great challenge in the management of DFU. It is very difficult to heal. Heel strike forms the first step in Walking Cycle. The body wt. transmission at Heel is maximum at Landing phage. Foot Biomechanics plays major role in healing of Heel DFU. 90% of Heel DFU end up with Calcaneal osteomyelitis & AK/BK amputation. Duaration of healing is pretty long, more than 6months. Outcome of Heel DFU in CRF, is very pathetic. Routine available modified foot wears for offloading hind foot lesions are not patient friendly. Patient has to plan to shift his body wt on forefoot. Thus Healing Heel DFU is a great challenge. We have simplified this process by designing Footwear which is patient friendly & he has normal walking cycle with healing within 3 months. Method: We plan normal foot wear with normal Heel height. The heel portion is drilled square shape as per DFU size & shape. The drilling of heel is done up to 3/4”.A 40% density foam is inserted into the drilled area of heel. This is prepared by sticking layers of foam of on one another which adds body wt sustaining capacity to the foam. After this we place a tapering shape foam on the inner aspect of foot wear with heel ht of 1”. Results: The foot biomechanics does not add body wt on Heel DFU as it remains suspended in air. Heel does not toch the ground. So the healing of DFU is fast. Pt is very comfortable with footwear. Conclusion: Simple modifications in foot wear can be economical & effective in healing difficult Heel DFU.
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