Treatment of resistant ulcers on the plantar surface of the great toe in diabetics.

Downs, Daniel M.; Jacobs, Richard L.

doi:10.2106/00004623-198264060-00017

Cited by 29 publications

(23 citation statements)

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“…Two small non‐controlled studies presented no recurrent ulcers at either 26 months or 2 to 5 years follow‐up after primary healing in patients who underwent either inter‐phalangeal joint arthroplasty or resection of the proximal phalanx of the great toe .…”

Section: Resultsmentioning

confidence: 99%

“…From the limited number of controlled studies, Achilles tendon lengthening, single or pan‐metatarsal head resection and metatarsophalangeal joint arthroplasty appear to reduce ulcer recurrence risk in selected patients with initially non‐healing ulcers when compared with non‐surgical treatment . Osteotomy also appears to reduce risk of ulcer recurrence, but it is not clear in comparison with what form of standard care . Several other surgical offloading procedures such as tendon transfer, plantar fascia release and digital flexor tendon tenotomy may be promising procedures to prevent ulcer recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Netten

Raspovic

Lavery

et al. 2016

Diabetes Metabolism Res

282

226

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Background Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Netten

Raspovic

Lavery

et al. 2016

Diabetes Metabolism Res

282

226

View full text Add to dashboard Cite

show abstract

“…The controlled studies showed relative risk reductions between 61.1% and 83.8% over conservative treatment. Two small retrospective cohort studies with high risk of bias and three non‐controlled studies showed low ulcer recurrence rates after metatarsal‐phalangeal or inter‐phalangeal joint arthroplasty . One of the cohort studies showed a relative risk reduction of 83.6% compared with conservative treatment.…”

Section: Surgical Offloading Interventionsmentioning

confidence: 99%

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Bus

Armstrong

Deursen

et al. 2016

Diabetes Metabolism Res

175

196

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RecommendationsCasting and prefabricated healing devices 1. To heal a neuropathic plantar forefoot ulcer without ischemia or uncontrolled infection in a patient with diabetes, offload with a non-removable knee-high device with an appropriate foot-device interface. (GRADE strength of recommendation: strong, Quality of evidence: high) 2. When a non-removable knee-high device is contraindicated or not tolerated by the patient, consider offloading with a removable knee-high walker with an appropriate foot-device interface to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the device. (Weak; Moderate) 3. When a knee-high device is contraindicated or cannot be tolerated by the patient, consider offloading with a forefoot offloading shoe, cast shoe, or custom-made temporary shoe to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the shoes. (Weak; Low) Therapeutic footwear4. To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) 5. Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent nonplantar ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles, or toe orthosis. (Strong; Low) 6. To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressurerelieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) 7. Do not prescribe, and instruct a patient with diabetes not to use, conventional or standard therapeutic shoes to heal a plantar foot ulcer. (Strong; Low) 8. Consider using shoe modifications, temporary footwear, toe spacers, or

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“…The results of these studies were discussed in the previous sub-chapter. Within the limitations of their designs, the results from level 3 studies suggest that molded and ethylene vinyl acetate (EVA) boots can play a role in ulcer healing [42,43], that various types of shoes and offloading insoles can, under some circumstances, result in healing [44][45][46][47], and that half-shoes can be effective in the treatment of plantar ulcers [23,48,49].…”

Section: Footwearmentioning

confidence: 99%

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

Bus

Valk

Deursen

et al. 2008

Diabetes Metab. Res. Rev.

219

182

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SummaryBackground Footwear and offloading techniques are commonly used in clinical practice for the prevention and treatment of foot ulcers in diabetes, but the evidence base to support this use is not well known. The goal of this review was to systematically assess the literature and to determine the available evidence on the use of footwear and offloading interventions for ulcer prevention, ulcer treatment, and plantar pressure reduction in the diabetic foot.

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Treatment of resistant ulcers on the plantar surface of the great toe in diabetics.

Cited by 29 publications

References 0 publications

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

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

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