In the individual with diabetes mellitus, foot ulceration represents the single most important risk factor in lower-extremity amputation. The goal of treatment is to obtain a healed and closed wound that (1) eliminates a portal of entry for bacterial invasion and development of limb-threatening infection, and (2) allows for tissue loading. This manuscript reviews current off-loading approaches to the treatment of plantar neuropathic foot ulcers, along with advantages and disadvantages of those techniques.

The preoperative and perioperative evaluation of diabetic foot pathologies has been discussed. The effects of vascular and neuropathic alterations in such cases can be devastating. Only through understanding of the underlying mechanisms that contribute to the diabetic foot can progressive, appropriate care be rendered.

Pressure ulcers are a common and serious secondary complication of spinal cord injury. In addition to being costly and difficult to treat, pressure ulcers may interfere with many aspects of patient and family life, including the ability to meet educational, vocational, and social goals. Treatment of pressure ulcers includes weekly assessment by a clinician, a requirement that often is impossible for clients to meet. In an effort to improve outcomes in wound care treatment, a rehabilitation center undertook an exploratory project to determine whether wound care via telerehabilitation was a viable alternative to clinic visits. Telerehabilitation is the use of telecommunication technology to deliver rehabilitation services at a distance. Eight patients being followed in the outpatient clinic participated in the project. The Picasso Still-Image Videophone was used to capture and send images from the patients' homes to the clinic. Findings from the exploratory study demonstrated that pressure ulcers can be successfully managed via telerehabilitation.