Pathogenesis of Foot Ulcers and the Need for Offloading

H. M. Rathur; A. J. M. Boulton

doi:10.1055/s-2005-861398

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2005; 37: 61-68
DOI: 10.1055/s-2005-861398

Review

Pathogenesis of Foot Ulcers and the Need for Offloading

H. M. Rathur¹ , A. J. M. Boulton¹

¹ Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK

Abstract

Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5 % of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15 %. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

Key words

Diabetic foot - Diabetic neuropathy - Foot ulcer - Amputation - Total Contact Cast (TCC)

Full Text

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Dr. H. M. Rathur MRCP

Manchester Royal Infirmary

Oxford Road · Manchester M13 9WL · UK ·

Phone: + 44(161)2764452

Fax: + 44(161)2744740

Email: harisrathur@hotmail.com