Bus SA
Plastic and reconstructive surgery. Date of publication 2016 Sep 1;volume 138(3 Suppl):179S-87S.
1. Plast Reconstr Surg. 2016 Sep;138(3 Suppl):179S-87S. doi:
10.1097/PRS.0000000000002686.
The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of
Recurrence.
Bus SA(1).
Author information:
(1)Amsterdam, The Netherlands From the Department of Rehabilitation, Academic
Medical Center, Amsterdam, The Netherlands.
BACKGROUND: An increased plantar pressure is a causative factor in the
development of plantar foot ulcers in people with diabetes mellitus, and ulcers
are a precursor of lower extremity amputation.
METHODS: In this article, the evidence is reviewed that relieving areas of
increased plantar pressure (ie, offloading) can heal plantar foot ulcers and
prevent their recurrence.
RESULTS: Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal
in 6 to 8 weeks with adequate offloading. Recent meta-analyses and systematic
reviews show that nonremovable knee-high devices are most effective. This is
probably because they eliminate the problem of nonadherence with the use of a
removable device. Studies show a large discrepancy between evidence-based
recommendations on offloading and what is used in clinical practice. Many clinics
continue to use methods that are less effective or have not been proven to be
effective, while ignoring evidence-based methods. Strategies are proposed to
address this issue, notably the adoption and implementation of recent
international guidelines by professional societies and a stronger focus of
clinicians on expedited healing. For the prevention of plantar foot ulcer
recurrence in high-risk patients, 2 recent trials have shown that the incidence
of recurrence can be significantly reduced with custom-made footwear that has a
demonstrated pressure-relieving effect through guidance by plantar pressure
measurements, under the condition that the footwear is worn.
CONCLUSION: This review helps to inform clinicians about effective offloading
treatment for healing plantar foot ulcers and preventing their recurrence.
DOI: 10.1097/PRS.0000000000002686
PMID: 27556758 [Indexed for MEDLINE]
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