Diabetic Foot Ulcers: Offloading, Surgery, and Beyond
Summary: At SAWC Spring 2026, Dr. Paul Kim and Dr. Johanna-Marie Richey delivered a practical, high-yield session on DFU management. They emphasized moving beyond simple wound closure to address underlying biomechanical abnormalities, perfusion, infection, and patient-specific factors. Key themes included thorough biomechanical evaluation (gait, deformities, joint ROM, weight-bearing imaging), distinguishing sagittal vs. shear forces, prioritizing non-operative offloading, and using surgery selectively to correct deformity and redistribute pressure. Minor amputations should be viewed as part of a limb-preservation strategy focused on function and preventing major amputation.
Key Highlights:
- Biomechanics is a primary driver of DFU development and recurrence
- Non-operative offloading remains first-line; surgery is reserved for correctable deformities
- Flexor tenotomy, metatarsal osteotomies, and Achilles lengthening discussed as targeted options
- Goal: stable, functional residual limb with low reulceration risk
- Authors/Speakers: Paul Kim, DPM, MS & Johanna-Marie Richey, DPM
Keywords: DFU offloading, diabetic foot surgery, biomechanical assessment, Paul Kim DPM