The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Bus, Sicco A.; Valk, Gerlof D.; Deursen, Robert William Martin Van; Armstrong, David G.; Caravaggi, C.; Hlaváček, Petr; Баккер, К.; Cavanagh, Peter R.

doi:10.1002/dmrr.850

Cited by 219 publications

(191 citation statements)

References 101 publications

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“…18,85 There also remain gaps in the knowledge about any benefit of potentially preventative interventions, such as patient education, routine podiatry, foot orthoses and specialist footwear. 84,[86][87][88] NICE recommends further research to identify the appropriate level and combination of risk factors used to categorise patients as being at high risk of ulceration and that these individuals should then be offered attendance on a protection programme. A UK-wide RCT to evaluate the clinical effectiveness and cost-effectiveness of such protection programmes is needed to evaluate the delivery of this type of health care.…”

Section: Secondary Analysesmentioning

confidence: 99%

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Crawford

Cézard

Chappell

et al. 2015

Health Technol Assess

158

196

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BackgroundAnnual foot risk assessment of people with diabetes is recommended in national and international clinical guidelines. At present, these are consensus based and use only a proportion of the available evidence.ObjectivesWe undertook a systematic review of individual patient data (IPD) to identify the most highly prognostic factors for foot ulceration (i.e. symptoms, signs, diagnostic tests) in people with diabetes.Data sourcesStudies were identified from searches of MEDLINE and EMBASE.Review methodsThe electronic search strategies for MEDLINE and EMBASE databases created during an aggregate systematic review of predictive factors for foot ulceration in diabetes were updated and rerun to January 2013. One reviewer applied the IPD review eligibility criteria to the full-text articles of the studies identified in our literature search and also to all studies excluded from our aggregate systematic review to ensure that we did not miss eligible IPD. A second reviewer applied the eligibility criteria to a 10% random sample of the abstract search yield to check that no relevant material was missed. This review includes exposure variables (risk factors) only from individuals who were free of foot ulceration at the time of study entry and who had a diagnosis of diabetes mellitus (either type 1 or type 2). The outcome variable was incident ulceration.ResultsOur search identified 16 cohort studies and we obtained anonymised IPD for 10. These data were collected from more than 16,000 people with diabetes worldwide and reanalysed by us. One data set was kept for independent validation. The data sets contributing IPD covered a range of temporal, geographical and clinical settings. We therefore selected random-effects meta-analysis, which assumes not that all the estimates from each study are estimates of the same underlying true value, but rather that the estimates belong to the same distribution. We selected candidate variables for meta-analysis using specific criteria. After univariate meta-analyses, the most clinically important predictors were identified by an international steering committee for inclusion in the primary, multivariable meta-analysis. Age, sex, duration of diabetes, monofilaments and pulses were considered most prognostically important. Meta-analyses based on data from the entire IPD population found that an inability to feel a 10-g monofilament [odds ratio (OR) 3.184, 95% confidence interval (CI) 2.654 to 3.82], at least one absent pedal pulse (OR 1.968, 95% CI 1.624 to 2.386), a longer duration of a diagnosis of diabetes (OR 1.024, 95% CI 1.011 to 1.036) and a previous history of ulceration (OR 6.589, 95% CI 2.488 to 17.45) were all predictive of risk. Female sex was protective (OR 0.743, 95% CI 0.598 to 0.922).LimitationsIt was not possible to perform a meta-analysis using a one-step approach because we were unable to procure copies of one of the data sets and instead accessed data via Safe Haven.ConclusionsThe findings from this review identify risk assessment procedures that can reliably inform national and international diabetes clinical guideline foot risk assessment procedures. The evidence from a large sample of patients in worldwide settings show that the use of a 10-g monofilament or one absent pedal pulse will identify those at moderate or intermediate risk of foot ulceration, and a history of foot ulcers or lower-extremity amputation is sufficient to identify those at high risk. We propose the development of a clinical prediction rule (CPR) from our existing model using the following predictor variables: insensitivity to a 10-g monofilament, absent pedal pulses and a history of ulceration or lower-extremities amputations. This CPR could replace the many tests, signs and symptoms that patients currently have measured using equipment that is either costly or difficult to use.Study registrationThis study is registered as PROSPERO CRD42011001841.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Secondary Analysesmentioning

confidence: 99%

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Crawford

Cézard

Chappell

et al. 2015

Health Technol Assess

158

196

View full text Add to dashboard Cite

show abstract

“…However, not all elderly patients or individuals with sedentary lifestyles sustain diabetic foot conditions. Studies have shown that proper diabetic control and proper foot care are vital for the overall prevention of diabetic foot conditions such as neuropathic ulcers, Charcot's arthropathy and lower limb infections (such as cellulitis, osteomyelitis and septic arthritis) (4)(5)(6)(7)(8). Improper prevention of diabetic foot conditions can result in significant morbidity, decreased function and quality of life (9).…”

Section: Introductionmentioning

confidence: 99%

Barriers and enablers to proper diabetic foot care amongst community dwellers in an Asian population: a qualitative study

Sayampanathan¹,

Cuttilan²,

Pearce³

2017

Ann. Transl. Med.

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“…In a lifetime, a person could cover, on his or her feet, a distance equal to more than 3 times the Earth's circumference. 1 Feet may be compromised by bacterial and fungal infections, 2-10 chronic disease, [10][11][12][13] obesity, 14 immune suppression, 9,10,15 vascular disease, 10,15 and uncomfortable or tight shoes. Tight shoes can injure the feet and make them prone to contamination and infections.…”

mentioning

confidence: 99%

Is it Possible to Sanitize Athletes' Shoes?

Messina

Burgassi

Russo

et al. 2015

Journal of Athletic Training

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Context: Footwear should be designed to avoid trauma and injury to the skin of the feet that can favor bacterial and fungal infections. Procedures and substances for sanitizing the interior of shoes are uncommon but are important aspects of primary prevention against foot infections and unpleasant odor.Objective: To evaluate the efficacy of a sanitizing technique for reducing bacterial and fungal contamination of footwear.Design: Crossover study. Setting: Mens Sana basketball team.Patients or Other Participants: Twenty-seven male athletes and 4 coaches (62 shoes).Intervention(s): The experimental protocol required a first sample (swab), 1/shoe, at time 0 from inside the shoes of all athletes before the sanitizing technique began and a second sample at time 1, after about 4 weeks, April 2012 to May 2012, of daily use of the sanitizing technique.Main Outcome Measure(s): The differences before and after use of the sanitizing technique for total bacterial count at 368C and 228C for Staphylococcus spp, yeasts, molds, Enterococcus spp, Pseudomonas spp, Escherichia coli, and total coliform bacteria were evaluated.Results: Before use of the sanitizing technique, the total bacterial counts at 368C and 228C and for Staphylococcus spp were greater by a factor of 5.8 (95% confidence interval [CI] ¼ 3.42, 9.84), 5.84 (95% CI ¼ 3.45, 9.78), and 4.78 (95% CI ¼ 2.84, 8.03), respectively. All the other comparisons showed a reduction in microbial loads, whereas E coli and coliforms were no longer detected. No statistically significant decrease in yeasts (P ¼ .0841) or molds (P ¼ .6913) was recorded probably because of low contamination.Conclusions: The sanitizing technique significantly reduced the bacterial presence in athletes' shoes.Key Words: athlete's foot, foot infections, bacterial infections, fungal infections, basketball, hygiene Key PointsMicrobes and pathogens can proliferate in athletes' shoes. Little research has been conducted on methods for sanitizing shoe interiors. The sanitizing technique was effective in reducing the bacterial load.

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The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Cited by 219 publications

References 101 publications

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Barriers and enablers to proper diabetic foot care amongst community dwellers in an Asian population: a qualitative study

Is it Possible to Sanitize Athletes' Shoes?

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