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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]
Appears in following Topics:
Diabetic Foot Ulcer - Treatment