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Offloading diabetic foot ulcers
Section:  Diabetic Foot

Dear colleagues,

I just read the last foot notes written by Robert Frykberg, and I want to comment from my experiences with treating DFU.

Dear Robert, I think you forgot one important item: patient's compliance.  Our treatment can be superb if the patient doesn't accept our advice we're nowhere.

I'm not a great admirer of the TCC for the following reasons:

1. labourintensive

2. much experience in application of a cast

3. only for Wagner 1 and 2 type of ulcers

4. not suitable with ischaemie or osteomyelitis

Therefore I've chosen the irremovable cast walker, and then not with an inlay as shown in fig. 3 (the Royce Medical device) with the removable plugs.  I got very bad results with this type of inlay.  Our orthotist makes a total contact inlay for each foot specific.  Furthermore we only us the Aircast diabetic walker.

It is not my intention to step on anyone's foot, I only hope to start an discussion concerning a problem we're faced with, which is spreading like a virus.

With regards, I hope I didn't made to many languages errors.

Alex Bots (Belgium)

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