Off-Loading for Diabetic Foot Disease

Sinacore, David R.; Mueller, Michael J.

doi:10.1016/b978-0-323-04145-4.50020-x

Cited by 6 publications

(4 citation statements)

References 65 publications

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“…Total contact casting is the goldstandard for off-loading and allows the patient to remain ambulatory. 13 A study by Ganguly et al compared treatment with total contact casting versus treatment with conventional dressings alone in patients with diabetic foot ulcers. 14 This study revealed that the total contact casting group had a statistically significant higher rate of wound closure as compared to the conventional dressings group.…”

Section: Co-morbidities Diabetesmentioning

confidence: 99%

Factors That Impair Wound Healing

Anderson

Hamm

2012

Journal of the American College of Clinical Wound Specialists

219

180

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The body's response to tissue injury in a healthy individual is an intricate, sequential physiologic process that results in timely healing with full re-epithelialization, resolution of drainage, and return of function to the affected tissue. Chronic wounds, however, do not follow this sequence of events and can challenge the most experienced clinician if the underlying factors that are impairing wound healing are not identified. The purpose of this article is to present recent information about factors that impair wound healing with the underlying pathophysiological mechanism that interferes with the response to tissue injury. These factors include co-morbidities (diabetes, obesity, protein energy malnutrition), medications (steroids, non-steroidal anti-inflammatory drugs or NSAIDs, anti-rejection medications), oncology interventions (radiation, chemotherapy), and life style habits (smoking, alcohol abuse). Successful treatment of any chronic wound depends upon identification and management of the factors for each individual.

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Section: Co-morbidities Diabetesmentioning

confidence: 99%

Factors That Impair Wound Healing

Anderson

Hamm

2012

Journal of the American College of Clinical Wound Specialists

219

180

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“…A greater percentage of TCC participants healed (93%) and healed faster (77 days) than RCW participants (65% healed in an average of 138 days), especially in participants with FF plantar DFUs (Table 2). Previous studies have shown that TCC is the most effective method of healing and offers the fastest healing times; 21–24 however, researchers have not routinely assessed and reported daily step activity during the offloading period. Further, daily step count and intensity of walking cadence often are not considered when selecting an offloading treatment device.…”

Section: Discussionmentioning

confidence: 99%

Offloading of Diabetic Neuropathic Plantar Ulcers: Secondary Analysis of Step Activity and Ulcer Healing

Wendland

Kline

Bohnert

et al. 2023

Adv Skin Wound Care

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OBJECTIVEAlthough it is well-known that offloading devices facilitate healing in people with diabetes and neuropathic plantar ulcers, little is known about how step activity affects healing. The purposes of this study were to compare: (1) healing outcomes (time to healing, percentage of ulcers healed); (2) healing rates by ulcer location; and (3) step activity (daily step count, daily peak mean cadence) among patients using either total contact casts (TCCs) or removable cast walker boots (RCWs).METHODSThe study included 55 participants (TCC, 29; RCW, 26) with diabetes mellitus, peripheral neuropathy, and a Wagner grade 1 or 2 neuropathic plantar ulcer. Each participant wore an activity monitor for 14 consecutive days. Step activity and healing variables were assessed using independent t tests, Kruskal-Wallis, Kaplan-Meier, and Mantel-Cox log-rank tests.RESULTSMean participant age was 55 (SD, 11) years. The percentage of ulcers healed was lower in the RCW group versus the TCC group (65% vs 93%). If healed, average healing rate was 77 (SD, 48) days in the TCC group and 138 (SD, 143) days in the RCW group. Survival distribution by ulcer location was different for RCW forefoot than other locations (132 ± 13 days vs 91 ± 15, 75 ± 11, and 102 ± 36 days for TCC forefoot, TCC-midfoot/hindfoot, and RCW-midfoot/hindfoot, respectively; χ2 = 10.69, P = .014). Average step count was 2,597 in the RCW group versus 1,813 steps in the TCC group (P = .07). The daily peak mean cadence for 20-, 30-, or 60-minute periods was greater with RCW use.CONCLUSIONSStep activity in participants with RCWs was increased compared with those with TCCs. Because of their potential to be easily removable, RCWs may impair ulcer healing by allowing greater step activity.

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“…Approximately 20% of diabetic foot ulcers are located on the plantar forefoot [ 1 , 2 ]. Total contact casts (TCCs) and cast walkers rendered irremovable are the gold standard to off-load and heal these ulcers [ 3 – 5 ], but they immobilize the ankle, which restricts daily life activities [ 3 ] and has negative effects on joint functioning [ 6 ]. A possible alternative would be an ankle-high device rendered irremovable, and a case study reported successful result with using a plaster shoe instead of a knee-high TCC [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

An innovative sealed shoe to off-load and heal diabetic forefoot ulcers – a feasibility study

Jarl

Tranberg

2017

Diabetic Foot & Ankle

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Background: Non-removable knee-high devices are the gold standard to treat diabetic foot ulcers located on the plantar forefoot, but they immobilize the ankle, which restricts daily life activities and has negative effects on joint functioning.Objective: To investigate the feasibility of sealing a therapeutic shoe to off-load and heal diabetic forefoot ulcers.Design: A case series of seven men with type 2 diabetes and a metatarsal head ulcer were prescribed therapeutic shoes and custom-made insoles. The shoe was sealed with a plastic band. Off-loading was assessed with the F-scan pressure measurement system. Adherence to wearing the shoe was assessed with a temperature sensor and by documenting the status of the seal.Results: The off-loading was effective and all ulcers healed. Median time to healing was 56 days (range 8–160). Complications were secondary ulcer (n = 1) and plantar hematoma (n = 1). Five of seven participants did not disturb the seal.Conclusions: Sealing a therapeutic shoe is a feasible way to off-load and heal forefoot ulcers. A controlled trial is needed to compare the effectiveness and safety of a sealed shoe to other non-removable devices.

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Off-Loading for Diabetic Foot Disease

Cited by 6 publications

References 65 publications

Factors That Impair Wound Healing

Factors That Impair Wound Healing

Offloading of Diabetic Neuropathic Plantar Ulcers: Secondary Analysis of Step Activity and Ulcer Healing

An innovative sealed shoe to off-load and heal diabetic forefoot ulcers – a feasibility study

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