Diabetic Foot Ulcers: Offloading, Surgery, and Beyond
At the Symposium on Advanced Wound Care (SAWC) Spring 2026 in Charlotte, NC, Paul Kim, DPM, MS, and Johanna-Marie Richey, DPM, delivered a clinically focused discussion on offloading, surgical decision-making, and limb preservation in diabetic foot ulcer (DFU) management. They emphasized that clinicians must correct underlying biomechanical abnormalities—not just achieve wound closure—to ensure durable healing. Both speakers advocated for a structured approach that integrates patient-level factors, mechanical assessment, and targeted intervention.
Assessment of Healing Potential
Dr. Kim outlined a practical framework for evaluating healing potential, focusing on bacterial burden, perfusion, tissue quality, and biomechanics. He emphasized that clinicians must evaluate these factors alongside patient-specific “host” variables, including nutritional status, social support, access to care, and overall medical complexity.
He highlighted mobility as a key clinical indicator that directly affects both healing and long-term outcomes. Clinicians should prioritize preserving mobility, he said, as loss of function has significant downstream consequences for patient health and independence.
Biomechanical Evaluation of the Foot
The session placed strong emphasis on biomechanics as a primary driver of DFU development and recurrence. Dr. Kim described the foot as a structure that must remain both flexible and rigid. When this balance is disrupted—due to deformity, neuropathy, or prior surgical intervention—focal pressure increases and tissue breakdown can follow.
He encouraged clinicians to rely on straightforward but intentional examination techniques. These include visual inspection of both plantar and dorsal surfaces, assessment of deformities, evaluation of joint range of motion, and observation of gait. Restricted motion, altered structure, and prior amputations all contribute to abnormal load redistribution. He cautioned that progressive removal of foot structures often leads to biomechanical instability and high rates of reulceration.
Read the full session summary on WoundSource.com.
