SURGICAL OFFLOADING OF PLANTAR HALLUX ULCERATIONS

Increased pressures at the plantar (bottom) aspect of the hallux (big toe) can potentially lead to very thick callus and potentially ulceration in patients with diabetes mellitus. Relieving pressure will help reduce callus build up and prevent ulceration from occurring.

Offloading is important as increased pressure can lead to further problems. In diabetics, where hyperkeratosis build up is occurring excessively on the big toes, it is important to get a shoe with a forefoot rockers to help reduce pressure on the toes. In patients that have open wounds/ulcerations, the gold standard would be to use a total contact cast to offload the diabetic foot ulcer. 

Courtesy of Barry Block, editor of PM News