Morona et al. 2013
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Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL. Comparison of the clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2013 Mar;29(3):183-93.
Design: Systematic Review & Meta-Analysis Methods: Literature was searched up until May 2012. The papers needed to describe the use of various orthotic devices in the treatment of chronic neuropathic ulcers. Outcomes: Adverse events, ulcers healed, time to healing, ulcer size change, amputations required. Results: • 13 studies included. • No differences found between devices for complete healing of ulcers. • Non-removable devices and walkers rendered irremovable were found to be equally effective for time to healing. • When encompassing all removable devices (inc. therapeutic shoes, walkers) and non-removable off-loading devices (total contact casts and walkers rendered irremovable), non-removable off-loading devices were found, to be more effective at promoting the healing of diabetic foot ulcers (p = 0.001).
Key message: Non-removable off-loading devices (cast or walker rendered irremovable) are more likely to result in ulcer healing than removable off-loading devices (due to compliance). However, no differences were found in terms of the 'complete healing of ulcers' with removable cast walkers from five studies.
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