A systematic review and meta-analysis of off-loading methods for diabetic foot ulcers

Journal of Vascular Surgery
Tarig ElraiyahM H Murad

Abstract

Increased plantar foot pressure is one of several key factors that lead to diabetic foot ulcers. Multiple methods have been proposed to relieve this pressure and thus enhance wound healing and potentially prevent relapse. We aimed in this systematic review to find the best available evidence for off-loading methods. We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest included complete wound healing, time to complete wound healing, amputation, infection, and relapse rates. We identified 19 interventional studies, of which 13 were randomized controlled trials, including data from 1605 patients with diabetic foot ulcers using an off-loading method. The risk of bias in the included studies was moderate. This analysis demonstrated improved wound healing with total contact casting over removable cast walker, therapeutic shoes, and conventional therapy. There was no advantage of irremovable cast walkers over total contact casting. There was improved healing with half-shoe compared with conventional wound care. Therapeutic shoes and insoles reduced relapse rate in comparison with regular footwe...Continue Reading

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Citations

Sep 28, 2018·Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society·Émilie Dufour, Arnaud Duhoux
Mar 6, 2019·Journal of Wound Care·Leanne AtkinWilliam Tettelbach
Mar 17, 2020·Diabetes/metabolism Research and Reviews·Peter A LazzariniSicco A Bus
Mar 17, 2020·Diabetes/metabolism Research and Reviews·Sicco A BusUNKNOWN International Working Group on the Diabetic Foot (IWGDF)
Aug 25, 2016·Plastic and Reconstructive Surgery·Sicco A Bus
Jan 1, 2020·Journal of Diabetes and Metabolic Disorders·Juliana Vallim JorgettoDenise Miyuki Kusahara
Aug 15, 2017·Diabetic Foot & Ankle·Gustav Jarl, Roy Tranberg
Oct 23, 2019·Journal of Diabetes Research·Vladimíra FejfarováVěra Lánská
Aug 13, 2017·Foot & Ankle International·Jonathan F Arnold, Valerie Marmolejo
Jun 29, 2018·EFORT Open Reviews·Önder I KılıçoğluŞamil Aktaş
Nov 22, 2020·Journal of Bodywork and Movement Therapies·André Augusto Martines Teixeira MendesMarcelo Cardoso de Souza
Jun 5, 2019·Journal of Vascular Surgery·Michael S ConteUNKNOWN GVG Writing Group
Nov 3, 2021·The British Journal of Dermatology·D C Bosanquet, K G Harding

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