From the Guidelines
The recommended weight-bearing protocol for healing plantar skin incisions involves using a non-removable knee-high offloading device as the first choice of offloading treatment to promote healing of the ulcer, as supported by the most recent guidelines 1.
Key Considerations
- The use of a non-removable knee-high offloading device, such as a total contact cast (TCC) or non-removable knee-high walker, is recommended for promoting healing of plantar forefoot or midfoot ulcers in persons with diabetes 1.
- For individuals who cannot tolerate a non-removable knee-high offloading device, a removable knee-high or ankle-high offloading device may be considered as a second choice, with the person encouraged to use the device during all weight-bearing activities 1.
- Conventional footwear or standard therapeutic footwear should not be used over an offloading device, as this can hinder the healing process 1.
Weight-Bearing Protocol
- The protocol typically involves complete offloading of the surgical site for an initial period, followed by gradual increases in weight bearing as tolerated.
- A surgical shoe, post-operative boot, or cast may be used to facilitate partial weight bearing, with full weight bearing usually resuming around 3-4 weeks post-incision, depending on wound healing progress.
- Elevation of the foot above heart level for 20-30 minutes several times daily can help reduce swelling and promote healing.
Wound Care
- Keeping the incision clean and dry, changing dressings as directed, and monitoring for signs of infection are crucial aspects of wound care.
- Premature pressure on plantar incisions can cause wound dehiscence, delayed healing, and increased scar tissue formation, highlighting the importance of a progressive approach to weight bearing.
- The plantar surface bears significant force during walking, and allowing adequate initial healing time before introducing mechanical stress optimizes tissue repair and minimizes complications.
From the Research
Weight-Bearing Protocol for Healing Plantar Skin Incisions
- The weight-bearing protocol for healing plantar skin incisions is crucial for effective recovery and prevention of further complications 2, 3, 4, 5.
- Studies have shown that partial weight bearing can reduce plantar peak forces, which is beneficial for healing plantar defects 3.
- The use of therapeutic shoes, such as bandage shoes, forefoot relief shoes, and short walkers, can also help reduce peak forces on the plantar region 3.
- In some cases, surgical reconstruction using flaps, such as the free vastus lateralis muscle flap or the medial plantar sensate flap, may be necessary to provide optimal soft tissue coverage and promote healing 4, 5.
- Preconditioning local vibrations have been shown to reduce reactive hyperemia after walking, which may help prevent foot ulcers in people with diabetes mellitus 6.
- The specific weight-bearing protocol may vary depending on the individual case and the type of reconstruction or treatment used, but the goal is to minimize stress and promote healing of the plantar skin incision 2, 3, 4, 5.
Key Considerations
- The plantar region is subject to high mechanical demands, including weight-bearing and shearing forces, which can impact the healing process 2, 3, 4, 5.
- The use of negative pressure wound therapy (NPWT) and conservative treatment with wound care can be effective in promoting healing of plantar defects 2.
- The selection of the appropriate reconstructive option, such as a flap or skin graft, depends on the size and location of the defect, as well as the individual patient's needs and circumstances 4, 5.