Effective and Economic Offloading of Diabetic Foot Ulcers in India with the Bohler Iron Plaster Cast

Saikia, Priyanka; Hariharan, Rajalakshmi; Shankar, Nachiket; Gaur, Anil; Jose, Naveen Matthew

doi:10.1007/s12262-015-1327-3

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…A validation set of 30 publications was created, including key studies known to the authors published since our previous search (July 29, 2014) . Using this set, the search strings used were validated; ie, each publication had to be identified before the search strings were used in this systematic review.…”

Section: Methodsmentioning

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: Methodsmentioning

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

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“…A study on the topic in LMICs represents a seminal contribution; this study unequivocally demonstrated that applying total contact casts significantly reduced the healing time and the incidence of major amputations among Indian patients grappling with DFUs. 49 …”

Section: Importance Of Early Intervention and Adequate Care Of Dfu; E...mentioning

confidence: 99%

“…this study unequivocally demonstrated that applying total contact casts significantly reduced the healing time and the incidence of major amputations among Indian patients grappling with DFUs. 49 Furthermore, another noteworthy study conducted in resourcelimited settings within India investigated the cost-effectiveness of offloading DFUs through the use of removable cast walkers. The findings of this study substantiated the merits of this approach, revealing remarkable enhancements in healing rates and a reduction in amputation rates among patients who availed themselves of removable cast walkers in comparison to those relying on traditional footwear or no offloading devices.…”

Section: Role Of Various Health Care Professionalsmentioning

confidence: 99%

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review

Swaminathan,

Awuah,

Bharadwaj

et al. 2024

Health Science Reports

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Background and AimsDiabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low‐ and Middle‐Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self‐care, and preventive measures to reduce amputation rates.MethodsA comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries.ResultsThe aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence‐based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing.ConclusionThe burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self‐care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow‐up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient‐centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.

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“…23 This offloading technique aids in healing by reducing the elevated plantar pressure and redistributing forces. 24 The pressure could thus be offloaded from the foot and redistributed to the shin or the upper part of the leg.…”

Section: Introductionmentioning

confidence: 99%

Computer designed orthotic device for offloading plantar ulcers—Technical paper

Kumar

Paul

Siva

2021

LEPROSY

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Introduction: Plantar ulcers occur in patients with peripheral arterial disease or peripheral neuropathy. Plantar ulcers resulting from the peak plantar pressures often lead to disabilities and even amputations. Using an appropriate offloading device would reduce peak plantar pressures and prevent ulcers.Objectives: To design and analyze a customized lightweight offloading device that will improve patient compliance and provide good aesthetic value, without compromising on efficacy. Computer Aided Design (CAD) software SOLIDWORKS was used to design two different 3-dimensional models of offloading devices. The light weight, energy efficient and cosmetically appealing offloading devices could be a replacement for the traditional offloading devices made of Plaster of Paris, which are bulky and unappealing, leading to poor compliance. Results: The computer simulation studies have established the efficacy of the new designs in offloading the foot. Conclusion:The developed designs could be an ideal replacement for traditional offloading devices like the Bohler iron. The designs could improve the user's compliance and acceptance without compromising on the efficacy. These designs need to be field tested.

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Effective and Economic Offloading of Diabetic Foot Ulcers in India with the Bohler Iron Plaster Cast

Cited by 5 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

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review

Computer designed orthotic device for offloading plantar ulcers—Technical paper

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