Kristin Bojrab

University of Indianapolis, Indianapolis,USA

Abstract Title:Offloading Techniques for the Plantar Diabetic Foot Wound: Optimizing Treatment Outcomes

Biography: Speaker at the Wild on Wounds Conference in September 2023. Speaker at the Advanced Wound Care Congress in February 2024, the Wild on Wounds Conference in August 2024 and the Indiana American Physical Therapy Association’s Fall Conference in November 2024. Poster presentation at SAWC in October 2024. Kristin graduated in 2013 with her doctorate in physical therapy from the University of Indianapolis. She currently practices in an outpatient PT driven wound clinic without physician oversight, while also working in a diabetic foot clinic with an infectious disease physician and amputee clinic with a PM&R physician. She has previously taught all of the wound care content at 5 different DPT programs in her specialty area. She holds several wound care certifications including; wound care certified, certified foot care specialist, a nutrition certification, and diabetic wound certification. She is also a fellow of the American College of Clinical Wound Specialists and serves on their clinical education committee. She has recently transitioned into academia where she is an associate professor at the University of Indianapolis Krannert School of Physical Therapy.

Research Interest: There is a significant gap between clinical practice and the evidence for offloading a diabetic foot ulcer; with a study recently reporting only 2.2% of providers documented offloading techniques. The total contact cast is the gold standard for offloading, but not always feasible or appropriate. Physical therapists practicing in PT-driven wound clinics, without physician oversight, are limited within the PT practice act; requiring additional communication and coordination of care to arrange for physician referrals, imaging, arterial studies and labs to confirm diabetic etiology and rule out osteomyelitis and arterial disease. Early clinical recognition of arterial disease and osteomyelitis in the diabetic foot ulcer is essential to optimize treatment for limb preservation and prevent surgical measures. A comprehensive evaluation is necessary to optimize treatment outcomes for diabetic foot ulcers; including debridement, controlling diabetes, smoking cessation, and appropriate offloading. Other offloading options are available that redistribute plantar pressures if the total contact cast is not feasible or appropriate. Further research is indicated on accessible and cost effective removable offloading devices and their effectiveness on healing plantar diabetic foot wounds, especially those that are more easily implemented into clinical practice. Learning Objectives: 1. Recall skilled physical therapy services that can be provided to optimize treatment outcomes. 2. Identify appropriate imaging and/or referrals necessary to optimize clinical outcomes and improve healing potential. 3. Describe the importance of complete offloading and/or management with a total contact cast as well as identify offloading techniques available when the TCC is not appropriate. Key Words: osteomyelitis, total contact cast, offloading, wounds