Pressure-related injury in a patient with diabetes

In this patient, abnormal foot biomechanics and poorly fitting shoes both contributed to the development of a chronic wound. A forefoot varus deformity, in addition to ankle joint equinus deformity, contributed to excessive lateral pressure. Radiographs were negative for osteomyelitis of the 5th metatarsal head, and off-loading using a boot with a rockerbottom sole that also immobilized the ankle provided effective treatment. Although the wound had been present for months, it healed up in about two weeks with appropriate off-loading.