Treating Hard-to-Heal Wounds

An Evidence-Based Approach for DFU and Chronic Wounds


This is a brief summary of a presentation given at the annual conference of Wounds Canada, in Mississauga, Ontario, on November 16th, 2017. It has been produced with the financial support of Integra Life Sciences. The presenter was Robert Fridman, DPM FACFAS CWSP, a fellowship-trained podiatric surgeon at the Department of Orthopaedic Surgery at New York-Presbyterian Columbia University Medical Center and the Department of Surgery at New York-Presbyterian Weill-Cornell Medical Center.


Normal Wound Healing
For health-care professionals, standard wound management consists of preparing the wound bed to support the healing process. When treating diabetic foot ulcers (DFUs), health-care professionals must work toward controlling infection, correcting ischemia, optimizing nutrition, correcting hyperglycemia and offloading of the wound.


Offloading is one of the cornerstones of effective management of a diabetic foot ulcer, as it helps to minimize repetitive trauma to the area. Total contact casting (TCC) has been established as the gold standard to achieve offloading while enabling patients to ambulate. TCC enables pressure to be transmitted to the cast wall or rearfoot, resulting in decreased forefoot pressure. The device also reduces gait speed and shortens stride length, resulting in reduction of pressure. Ankle movement and the propulsive phase of gait are reduced, resulting in a reduction in vertical loading forces (see Figure 1). Ninety percent of DFUs have been shown to heal within six weeks when treated with a TCC … read more