Definitions and criteria for diabetic foot disease

Netten, Jaap J. van; Bus, Sicco A.; Apelqvist, Jan; Lipsky, Benjamin A.; Hinchliffe, Robert J.; Game, Frances; Rayman, Gerry; Lazzarini, Peter A; Forsythe, Rachael; Peters, Edgar J.G.; Senneville, Éric; Vas, Prashanth; Monteiro‐Soares, Matilde; Schaper, Nicolaas C.

doi:10.1002/dmrr.3268

Cited by 283 publications

(377 citation statements)

References 11 publications

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“…In brief, the primary outcome was a healed DFU, typically defined by studies as complete epithelialization. 20,23,24 Surrogate outcomes were changes in plantar pressure, ulcer area, ambulatory activity, and adherence. 20,23,24 Plantar pressure was typically defined by studies as peak plantar pressure or peak pressure time integral.…”

Section: Discussionmentioning

confidence: 99%

“…20,23,24 Surrogate outcomes were changes in plantar pressure, ulcer area, ambulatory activity, and adherence. 20,23,24 Plantar pressure was typically defined by studies as peak plantar pressure or peak pressure time integral. 20,23,24 Ulcer area was typically defined as ulcer surface area.…”

Section: Discussionmentioning

confidence: 99%

“…The population of interest for this review were people with a DFU, defined as any full thickness lesion below the malleoli associated with peripheral neuropathy and/or peripheral artery disease in people with diabetes. 20,23,24 People at-risk of DFU were also eligible if they were specifically being used as a "surrogate DFU population" to test offloading interventions for potential offloading effectiveness in a future DFU population. Those at-risk were defined as people with diabetes and previous DFU, peripheral neuropathy, or peripheral arterial disease.…”

Section: Populationmentioning

confidence: 99%

“…Those at-risk were defined as people with diabetes and previous DFU, peripheral neuropathy, or peripheral arterial disease. 20,23,24…”

Section: Populationmentioning

confidence: 99%

“…All clinical questions can be found within this paper and all definitions can be found in accompanying IWGDF publications. 20,23,24…”

mentioning

confidence: 99%

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

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Populationmentioning

confidence: 99%

“…Those at-risk were defined as people with diabetes and previous DFU, peripheral neuropathy, or peripheral arterial disease. 20,23,24…”

Section: Populationmentioning

confidence: 99%

“…All clinical questions can be found within this paper and all definitions can be found in accompanying IWGDF publications. 20,23,24…”

mentioning

confidence: 99%

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

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

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246

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Telemedicine for the treatment of foot ulcers in people with diabetes

Prestes

Amaral

Nakano

et al. 2021

Cochrane Database of Systematic Reviews

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Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Lavery

Monteiro‐Soares

et al. 2020

Diabetes Metabolism Res

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374

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at‐risk patient about appropriate foot self‐care and treat any pre‐ulcerative sign on the foot. Instruct moderate‐to‐high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non‐surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high‐risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer‐free days, and to reduce the patient and health care burden of diabetic foot disease.

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Definitions and criteria for diabetic foot disease

Cited by 283 publications

References 11 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

Telemedicine for the treatment of foot ulcers in people with diabetes

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

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