A Comparative Study Between Total Contact Cast and Pressure-Relieving Ankle Foot Orthosis in Diabetic Neuropathic Foot Ulcers

Chakraborty, Partha Pratim; Ray, Sayantan; Biswas, Dibakar; Baidya, Arjun; Bhattacharjee, Rana; Mukhopadhyay, Pradip; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

doi:10.1177/1932296814560788

Cited by 26 publications

(18 citation statements)

References 22 publications

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“…Felted foam applied to the forefoot with a cut out to the ulcer area seems more effective at reducing plantar pressure over 1 week compared with no felted foam Low Pabon-Carrasco et al 2016 114 and Raspovic et al 2016 37 Achilles tendon lengthening in addition to a TCC seems more effective at reducing peak pressures at the forefoot in the short term than a TCC alone, but not in the long term, and at the expense of increases in rearfoot peak pressure. 54 Strakhova et al 2014, 73 Faglia et al 2010, 56 Van de Weg et al 2008, 58 Removable knee-high offloading devices seem to be associated with greater reductions in ambulatory activity than removable ankle-high offloading devices…”

Section: Moderate Hastings Et Al 2012 66mentioning

confidence: 99%

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

246

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Background Offloading interventions are commonly used in clinical practice to heal foot ulcers. The aim of this updated systematic review is to investigate the effectiveness of offloading interventions to heal diabetic foot ulcers. Methods We updated our previous systematic review search of PubMed, EMBASE, and Cochrane databases to also include original studies published between July 29, 2014 and August 13, 2018 relating to four offloading intervention categories in populations with diabetic foot ulcers: (a) offloading devices, (b) footwear, (c) other offloading techniques, and (d) surgical offloading techniques. Outcomes included ulcer healing, plantar pressure, ambulatory activity, adherence, adverse events, patient‐reported measures, and cost‐effectiveness. Included controlled studies were assessed for methodological quality and had key data extracted into evidence and risk of bias tables. Included non‐controlled studies were summarised on a narrative basis. Results We identified 41 studies from our updated search for a total of 165 included studies. Six included studies were meta‐analyses, 26 randomised controlled trials (RCTs), 13 other controlled studies, and 120 non‐controlled studies. Five meta‐analyses and 12 RCTs provided high‐quality evidence for non‐removable knee‐high offloading devices being more effective than removable offloading devices and therapeutic footwear for healing plantar forefoot and midfoot ulcers. Total contact casts (TCCs) and non‐removable knee‐high walkers were shown to be equally effective. Moderate‐quality evidence exists for removable knee‐high and ankle‐high offloading devices being equally effective in healing, but knee‐high devices have a larger effect on reducing plantar pressure and ambulatory activity. Low‐quality evidence exists for the use of felted foam and surgical offloading to promote healing of plantar forefoot and midfoot ulcers. Very limited evidence exists for the efficacy of any offloading intervention for healing plantar heel ulcers, non‐plantar ulcers, and neuropathic ulcers with infection or ischemia. Conclusion Strong evidence supports the use of non‐removable knee‐high offloading devices (either TCC or non‐removable walker) as the first‐choice offloading intervention for healing plantar neuropathic forefoot and midfoot ulcers. Removable offloading devices, either knee‐high or ankle‐high, are preferred as second choice over other offloading interventions. The evidence bases to support any other offloading intervention is still weak and more high‐quality controlled studies are needed in these areas.

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Section: Moderate Hastings Et Al 2012 66mentioning

confidence: 99%

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

246

View full text Add to dashboard Cite

show abstract

“…Thus, there seems to be a need for the development of new offloading interventions that not only demonstrate effectiveness in healing DFU but also are inexpensive, readily available, and suitable for local situations particularly in developing countries . A number of promising offloading interventions have recently been developed that may help provide the evidence for future gold standard guideline offloading recommendations that are more easily implementable in future …”

Section: Discussionmentioning

confidence: 99%

Differences between national and international guidelines for the management of diabetic foot disease

Parker

Netten

Parker

et al. 2018

Diabetes Metabolism Res

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Aim No studies have investigated if national guidelines to manage diabetic foot disease differ from international guidelines. This study aimed to compare guidelines of Western Pacific nations with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. Methods The 77 recommendations in five chapters of the 2015 IWGDF guidance documents were used as the international gold standard reference. The IWGDF national representative(s) from 12 Western Pacific nations were invited to submit their nation's diabetic foot guideline(s). Four investigators rated information in the national guidelines as “similar,” “partially similar,” “not similar,” or “different” when compared with IWGDF recommendations. National representative(s) reviewed findings. Disagreements in ratings were discussed until consensus agreement achieved. Results Eight of 12 nations (67%) responded: Australia, China, New Zealand, Taiwan, and Thailand provided national guidelines; Singapore provided the Association of Southeast Asian Nations guidelines; and Hong Kong and the Philippines advised no formal national diabetic foot guidelines existed. The six national guidelines included were 39% similar/partially similar, 58% not similar, and 2% different compared with the IWGDF recommendations. Within individual IWGDF chapters, the six national guidelines were similar/partially similar with 53% of recommendations for the IWGDF prevention chapter, 42% for wound healing, 40% for infection, 40% for peripheral artery disease, and 20% for offloading. Conclusions National diabetic foot disease guidelines from a large and diverse region of the world showed limited similarity to recommendations made by international guidelines. Differences between recommendations may contribute to differences in national diabetic foot disease outcomes and burdens.

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“…Besides that, the wound is still highly susceptible to infection and this will delay wound healing after prolonged wear [ 9 ]. Currently, research has been performed to strategize and to find other potential alternatives to TCC [ 12 ] such as improved or enhanced wound dressings [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Antibacterial-Integrated Collagen Wound Dressing for Diabetes-Related Foot Ulcers: An Evidence-Based Review of Clinical Studies

et al. 2020

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Diabetic foot ulcer (DFU) is a chronic wound frequently delayed from severe infection. Wound dressing provides an essential barrier between the ulcer and the external environment. This review aimed to analyse the effectiveness of antibacterial collagen-based dressing for DFU treatment in a clinical setting. An electronic search in four databases, namely, Scopus, PubMed, Ovid MEDLINE(R), and ISI Web of Science, was performed to obtain relevant articles published within the last ten years. The published studies were included if they reported evidence of (1) collagen-based antibacterial dressing or (2) wound healing for diabetic ulcers, and (3) were written in English. Both randomised and non-randomised clinical trials were included. The search for relevant clinical studies (n) identified eight related references discussing the effectiveness of collagen-based antibacterial wound dressings for DFU comprising collagen impregnated with polyhexamethylene biguanide (n = 2), gentamicin (n = 3), combined-cellulose and silver (n = 1), gentian violet/methylene blue mixed (n = 1), and silver (n = 1). The clinical data were limited by small sample sizes and multiple aetiologies of chronic wounds. The evidence was not robust enough for a conclusive statement, although most of the studies reported positive outcomes for the use of collagen dressings loaded with antibacterial properties for DFU wound healing. This study emphasises the importance of having standardised clinical trials, larger sample sizes, and accurate reporting for reliable statistical evidence confirming DFU treatment efficiency.

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A Comparative Study Between Total Contact Cast and Pressure-Relieving Ankle Foot Orthosis in Diabetic Neuropathic Foot Ulcers

Cited by 26 publications

References 22 publications

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Differences between national and international guidelines for the management of diabetic foot disease

Antibacterial-Integrated Collagen Wound Dressing for Diabetes-Related Foot Ulcers: An Evidence-Based Review of Clinical Studies

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