Snyder RJ, Frykberg RG, Rogers LC, Applewhite AJ, Bell D, Bohn G, Fife CE, Jensen J, Wilcox J, et al.
Journal of the American Podiatric Medical Association. Date of publication 2014 Nov 1;volume 104(6):555-67.
1. J Am Podiatr Med Assoc. 2014 Nov;104(6):555-67. doi: 10.7547/8750-7315-104.6.555.
The management of diabetic foot ulcers through optimal off-loading: building
consensus guidelines and practical recommendations to improve outcomes.
Snyder RJ, Frykberg RG, Rogers LC, Applewhite AJ, Bell D, Bohn G, Fife CE, Jensen
J, Wilcox J.
BACKGROUND: We sought to develop a consensus statement for the use of off-loading
in the management of diabetic foot ulcers (DFUs).
METHODS: A literature search of PubMed for evidence regarding off-loading of DFUs
was initially conducted, followed by a meeting of authors on March 15, 2013, in
Philadelphia, Pennsylvania, to draft consensus statements and recommendations
using the GRADE (Grading of Recommendations Assessment, Development, and
Evaluation) approach to assess quality of evidence and develop strength of
recommendations for each consensus statement.
RESULTS: Evidence is clear that adequate off-loading increases the likelihood of
DFU healing and that increased clinician use of effective off-loading is
necessary. Recommendations are included to guide clinicians on the optimal use of
off-loading based on an initial comprehensive patient/wound assessment and the
necessity to improve patient adherence with off-loading devices.
CONCLUSIONS: The likelihood of DFU healing is increased with off-loading
adherence, and, current evidence favors the use of nonremovable casts or fixed
ankle walking braces as optimum off-loading modalities. There currently exists a
gap between what the evidence supports regarding the efficacy of DFU off-loading
and what is performed in clinical practice despite expert consensus on the
standard of care.
DOI: 10.7547/8750-7315-104.6.555
PMID: 25514266 [Indexed for MEDLINE]
