Diabetic Ulcer Research O/V

Lazzarini et al. 2020

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Lazzarini PA, Jarl G, Gooday C, Viswanathan V, Caravaggi CF, Armstrong DG, Bus SA. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review. Diabetes Metab Res Rev. 2020 Mar;36 Suppl1(Suppl1):e3275.

Design: Systematic Review Methods: PubMed, EMBASE, and Cochrane databases were searched (July 2014-August 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, adherence, adverse events, cost-effectiveness etc. Results:

41 studies were included.

Key message: Cast and knee-high walkers rendered irremovable are equally effective and the first-choice off-loading intervention for diabetic ulcers.

• High-quality evidence was found 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.

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