We see many diabetic foot ulcers in the office. My goal is to not only heal the wounds, BUT also prevent recurrent wounds. An example is: A diabetic foot ulcer on the plantar hallux base. On exam of the mechanics of this particular foot there is a functional hallux limitus. Once this ulceration is healed, what can you do to decrease the pressure to this region? AND prevent recurrence?

Couple thoughts on this one:
– functional foot orthotic with a diabetic top cover and addition, or integration, of a reverse Morton extension to allow plantarflexion of the 1st metatarsal. This will offer decreased pressure to the otherwise jammed hallux and the limitus.

– next, you must decrease the recurrent friction. The best way to do this is to add a piece of PTFE (minimal coefficient of friction) to the area that the hallux and first metatarsal head contact.

Together, these modifications will help to decrease the recurrence rate of the ulceration.