Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review

Bus, Sicco A.; Deursen, Robert William Martin Van; Armstrong, David G.; Lewis, Jane; Caravaggi, Carlo; Cavanagh, Peter R.

doi:10.1002/dmrr.2702

Cited by 243 publications

(227 citation statements)

References 194 publications

(280 reference statements)

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“…Guideline and grading adopted from SIGN risk stratification system Legend: * Guideline based on 7 systematic reviews created by IWGDF working groups. The reviews are related to different topics: 1) prevention [22], 2) footwear [23], 3) PAD diagnosis [24], 4) PAD prognosis [25], 5) PAD therapy [26], 6) infection [27], and 7) wound healing [28]. Each group applied its own grading system, usually either the GRADE or the SIGN system.…”

Section: Protocolmentioning

confidence: 99%

See 1 more Smart Citation

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

Formosa¹,

Gatt²,

Chockalingam³

2016

Rev Diabet Stud

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■ Abstract AIM:To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure. METHODS: A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'. RESULTS: Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them. CONCLUSIONS: Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence.

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Section: Protocolmentioning

confidence: 99%

“…Table 1 lists the ten guidelines on foot screening along with the details of the publishing organization, and shows the references to the guidelines and the evidence-grading systems used by the organizations [2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Search Strategy and Guidelines Includedmentioning

confidence: 99%

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

Formosa¹,

Gatt²,

Chockalingam³

2016

Rev Diabet Stud

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“…16 Systematic reviews indicate that the use of nonremovable casting devices like TCCs significantly improve healing of neuropathic plantar forefoot ulcers compared with removable offloading devices. 17 TCCs are casts molded to the shape of the plantar foot that extend from the distal phalanges, across the osseous prominences of the plantar foot and beyond the back of the heel, proximally up the leg.…”

Section: Casting Methods For Offloadingmentioning

confidence: 99%

Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission

Boghossian¹,

Miller²,

Armstrong³

2017

CWCMR

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Management of the diabetic foot is multifaceted and requires constant monitoring from patients and health care providers. The alarmingly high rate of recurrence of ulcerations in diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. With its high rates of morbidity and recurrence, care of the complex diabetic foot may be aptly comparable to many forms of cancer. Therefore, our efforts should be not only in rapid healing of open wounds but also in maximizing ulcer-free days for the patient in diabetic foot remission. One facet of the multidisciplinary approach in managing wounds is achieved by reducing peak plantar pressures by offloading the foot with various conservative and surgical techniques aimed at reducing areas of stress caused by ambulation and improper shoe gear. Evidence supports the use of total contact casts as the gold standard for offloading open wounds; however, other methods have gained popularity as well. Novel approaches in surgical techniques and advances in wearable technology appear to show promise in measuring and modulating dangerous pressure and inflammation to extend remission and improve quality of life for these most complex patients. Keywords: diabetic foot, ulcer, remission, amputation, offloading, wearables Diabetes and other noncommunicable diseases of decay are now the leading cause of global mortality in the developed and developing world.1 As the continuously growing epidemic of diabetes further expands, it inflicts affected patients with a myriad of subsequent diabetic complications and comorbidities that necessitate further financial investments in managing these patients in a multidisciplinary setting to save limbs from amputation. There are several well-known guidelines for prolonging remission from ulceration in the diabetic foot with the mind-set of "active prevention", including having a heightened awareness of these risk factors associated with ulceration, patient education, staying active, frequent inspection of the feet, reducing friction by wearing diabetic socks and proper footwear, avoiding self-injurious behavior such as walking barefoot, and long-term management of the various comorbid systemic diseases associated with diabetes. 2,3 Due to the economic, physical, and psychological cost of diabetic foot ulcers (DFUs), efforts to delay or prevent their development are a prudent use of medical resources. Remarkably, people with DFUs have a risk of hospitalization that is comparable to or exceeding heart failure, pulmonary disease, renal disease, and most cancers. 4 Patients with diabetes mellitus (DM) undergoing treatment of DFUs often present with confounding factors and subsequently experience high rates of recurrence. Of the individuals who successfully heal a DFU, the risk of ulcer recurrence within

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“…Despite these interventions, recurrence rates of ulcers remain high, with some studies reporting upwards of 40% recurrence. 10,11,35 The high recurrence rate is likely due to the fact that the underlying pathology (the peripheral neuropathy and PAD) are still present regardless of ulcer resolution. With chronic or recurrent ulcers, physicians should carefully monitor for infection and be aware of the risk factors for infection discussed below.…”

Section: Advanced Healing Modalitiesmentioning

confidence: 99%

The Evaluation and Treatment of Diabetic Foot Ulcers and Diabetic Foot Infections

Core

Ahn

Lewis

et al. 2018

Foot & Ankle Orthopaedics

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Diabetic foot ulcers and infections are common complications of diabetic foot disease. Additionally, these complications are a common cause of morbidity and impose a substantial burden to the patient and society. It is imperative to understand the major contributing factors, namely, diabetic neuropathy, peripheral arterial disease, and immune system dysfunction in order to guide treatment. Management of diabetic foot disease begins with a detailed history and thorough physical examination. This examination should focus on the manifestations of diabetic neuropathy and peripheral arterial disease, and, in particular, any evidence of diabetic foot ulcers or infection. Prevention strategies should include a multi-disciplinary approach centered on patient education.

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Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review

Cited by 243 publications

References 194 publications

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission

The Evaluation and Treatment of Diabetic Foot Ulcers and Diabetic Foot Infections

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