Elraiyah T, Prutsky G, Domecq JP, Tsapas A, Nabhan M, Frykberg RG, Firwana B, Hasan R, Prokop LJ, Murad MH, et al.
Journal of vascular surgery. Date of publication 2016 Feb 1;volume 63(2 Suppl):59S-68S.e1-2.
1. J Vasc Surg. 2016 Feb;63(2 Suppl):59S-68S.e1-2. doi: 10.1016/j.jvs.2015.10.006.
A systematic review and meta-analysis of off-loading methods for diabetic foot
ulcers.
Elraiyah T(1), Prutsky G(2), Domecq JP(2), Tsapas A(3), Nabhan M(1), Frykberg
RG(4), Firwana B(5), Hasan R(5), Prokop LJ(6), Murad MH(7).
Author information:
(1)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
(2)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de
Conocimiento y Evidencia (CONEVID), Lima, Peru.
(3)Second Medical Department, Aristotle University Thessaloniki, Thessaloniki,
Greece.
(4)Phoenix VA Health Care System, Phoenix, Ariz.
(5)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of
Internal Medicine, University of Missouri, Columbia, Mo.
(6)Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
(7)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of
Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
Electronic address: murad.mohammad@mayo.edu.
BACKGROUND: 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.
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.
RESULTS: 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
footwear. Data were sparse regarding other off-loading methods.
CONCLUSIONS: Although based on low-quality evidence (ie, evidence warranting
lower certainty), benefits are demonstrated for use of total contact casting and
irremovable cast walkers in the treatment of diabetic foot ulcers. Reduced
relapse rate is demonstrated with various therapeutic shoes and insoles in
comparison with regular footwear.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1016/j.jvs.2015.10.006
PMID: 26804369 [Indexed for MEDLINE]
