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Background: Offloading interventions are commonly used in clinical practice to heal foot ulcers. The aim of this updated systematic review is to investigate the effectiveness of offloading interventions to heal diabetic foot ulcers. Methods: We updated our previous systematic review search of PubMed, EMBASE, and Cochrane databases to also include original studies published between July 29, 2014 and August 13, 2018 relating to four offloading intervention categories in populations with diabetic foot ulcers: (a) offloading devices, (b) footwear, (c) other offloading techniques, and (d) surgical offloading techniques. Outcomes included ulcer healing, plantar pressure, ambulatory activity, adherence, adverse events, patient-reported measures, and cost-effectiveness. Included controlled studies were assessed for methodological quality and had key data extracted into evidence and risk of bias tables. Included non-controlled studies were summarised on a narrative basis. Results: We identified 41 studies from our updated search for a total of 165 included studies. Six included studies were meta-analyses, 26 randomised controlled trials (RCTs), 13 other controlled studies, and 120 non-controlled studies. Five meta-analyses and 12 RCTs provided high-quality evidence for non-removable knee-high offloading devices being more effective than removable offloading devices and therapeutic footwear for healing plantar forefoot and midfoot ulcers. Total contact casts (TCCs) and non-removable knee-high walkers were shown to be equally effective. Moderate-quality evidence exists for removable knee-high and ankle-high offloading devices being equally effective in healing, but knee-high devices have a larger effect on reducing plantar pressure and ambulatory activity. Low-quality evidence exists for the use of felted foam and surgical offloading to promote healing of plantar forefoot and midfoot ulcers. Very limited evidence exists for the e

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee-high offloading device is the first choice of offloading treatment. A removable knee-high and removable ankle-high offloading device are to be considered as the second- and third-choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth-choice offloading treatment. If non-surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at ri

The International Working Group on the Diabetic Foot (IWGDF) has published evidence - based guideline s on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote healing foot ulcers in persons with diabetes and updates the previous IWGDF guideline . We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format , to conduct a systematic review of the medical - scientific literature , and to write recommendations and the irrationale. The recommendations are based on the quality of evidence found in the systematic review , expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, w e recommend that a non - removable knee - high offloading device is the first - choice of offloading treatment . A removable knee - high and removable ankle - high offloading device are to be considered as the second - and third - choice offloading treatment , respectively , if contraindications or patient intolerance to non - removable offloading exist . Appropriately fitting footwear combine d with felted foam can be considered as the fourth - choice offloading treatment. If non - surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischemia, and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes . Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have

Tento článek je specifickým průvodcem obuví a jejich úprav pro diabetickou nohu, založených na závěrech ze systematicky probíraného přehledu publikací a souhlasné shody se závěry mezinárodní pracovní skupiny pro diabetickou nohu., This article is a specific guideline on footwear and offloading for the diabetic foot which is based on conclusions from the systematic review on available evidence and on consensus agreement within the International Working Group on the Diabetic Foot.

Používání speciální obuvi a odlehčovacích technik je v klinické praxi používáno jako prevence zejména v případech výskytu ulcerace na nohách diabetiků. Vyhodnocení a způsob využívání však není dostatečně znám. Cílem tohoto přehledu bylo systematicky zpřístupnit pravidla pro stanovení dostupnosti evidence na použití obuvi a odlehčujících zásahů z důvodu prevence ulcerace a redukce plantárních tlaků na diabetické noze. Výzkum byl založen na zpracování zpráv o účinnosti použití obuvi a odlehčovacích zásahů z pohledu prevence nebo léčení nožní ulcerace nebo redukce plantárních tlaků nohou u diabetických pacientů publikovaných do května 2006. Všechny publikované studie byly zahrnuty odhady metodických studií a data extrakce byly nezávisle předvedeny dvěma posuzovateli. Zásahy byly označeny a kategorizovány do čtyř skupin: ošetření, obuv, operační odlehčení a další odlehčovací techniky., Background 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. Methods A search was made for reports on the effectiveness of footwear and offloading interventions in preventing or healing foot ulcers or reducing plantar foot pressure in diabetic patients published prior to May 2006. Both controlled and uncontrolled studies were included. Assessment of the methodological quality of studies and data extraction was independently performed by two reviewers. Interventions were assigned into four subcategories: casting, footwear, surgical offloading and other offloading techniques.