HOW TO SELECT AN APPROPRIATE OFFLOADING DEVICE

For successful outcomes, choice of offloading devices may be guided by the criteria outlined in Algorithm 1 below.

Criteria relevant for decision making is also itemized below: 

• Evidence, as defined by availability of RCTs. See section 'Evidence and Recommendations' in topic "Offloading Devices"
• Careful weighing of benefits and harms, appropriate, patient and ulcer-specific product selection 
• • Presence of comorbidities, such as peripheral artery disease and infection
  • Local factors such as location of the ulcer, ulcer chronicity/ recurrence/ healing rate, callus thickness and hardness
  • Offloading device indications, contraindications and features 
• Patient’s and clinician’s preference and familiarity with the product
• • Clinician's familiarity with the device
  • Patient adherence to use of the device
  • Patient work and life-style requirements
    
• Availability of resources and cost-effectiveness
• • Availability of a podiatrist for consideration of surgical offloading if indicated
  • Reimbursement
  • • See section 'Coding, Coverage and Reimbursement' in topic "Offloading Device"
    • Patient co-pay
• Adherence to standard of care :
• • Meticulous wound bed preparation, including removal of exudate and necrotic tissue, infection control, nutritional support
  • Diligent patient preparation and correction of systemic cofactors that impair healing;
  • Aggressive correction of the underlying wound etiology;
  • Proper application of offloading device (e.g. total contact cast)
  • Consistent, regular monitoring of outcomes