Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Podiatric Medicine


Tom Colletti, DHSc, PA-C, DFAAPA


Objective: Offloading is a key principle to healing diabetic foot ulcers (DFUs). The total contact cast (TCC) and knee-high irremovable offloading devices are respected as the gold standard for DFU offloading. However, patients exhibit a limited tolerance for these devices which contributes to a lack of their use. The purpose of this case report is to share two different alternative offloading modalities for knee-high irremovable offloading devices for the treatment of DFUs.

Methods: Two patients with diabetic foot ulcers were included in this case report. One patient was managed with the use of the football offloading dressing, and the other patient was managed with a modified felted football dressing.

Results: Evidence-based research supports offloading for healing diabetic foot ulcerations but is limited regarding the utilization of football offloading and modified felted football dressings.

Conclusion: Offloading has been shown to be effective in healing diabetic foot ulcers, with a gold standard dressing of the TCC. This modality requires specialized training, prolonged time for application, high cost, and is often not well tolerated by patients. The football and modified felted football offloading dressings provide a cost-effective, less time-consuming application, and often a better-tolerated alternative to the TCC. Clinical findings support further investigation into dressing options tolerated by patients with improved compliance and optimal healing outcomes.


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