The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers

Effective off-loading is considered to be an important part of the successful clinical management of diabetic foot ulcers. The aim of this systematic review is to investigate the safety and effectiveness of different off-loading devices for the treatment of diabetic foot ulcers. The medical literature was extensively searched from January 1966 to May 2012. Systematic reviews and controlled studies that compared the use of different off-loading devices formed the evidence base. Studies were critically appraised to determine their risk of methodological bias, and data were extracted. Results were pooled using random effects meta-analysis and tested for heterogeneity. When compared with removable devices, non-removable off-loading devices were found, on average, to be more effective at promoting the healing of diabetic foot ulcers (RRp = 1.43; 95% CI 1.11, 1.84; I(2) = 66.9%; p = 0.001; k = 10). Analysis, stratified by type of removable device, did not detect a statistically significant difference between non-removable off-loading devices and removable cast walkers; however, on average non-removable off-loading devices performed better than therapeutic shoes at promoting the healing of diabetic foot ulcers (RRp = 1.68; 95% CI 1.09, 2.58; I(2) = 71.5%; p = 0.004; k = 6). The two types of non-removable off-loading devices i.e. total contact casts and instant total contact casts (removable cast walker rendered irremovable by securing with bandage or lace), were found to be equally effective (RRp = 1.06; 95% CI 0.88, 1.27; I(2) = 3.3%; p = 0.31; k = 2). In conclusion, non-removable off-loading devices regardless of type, are more likely to result in ulcer healing than removable off-loading devices, presumably because patient compliance with off-loading is facilitated.

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“… and 90% of patients in the study by Zimny et al . . The proportion of Wagner grade 1 and grade 2 ulcers in the study by Gutekunst et al .…”

Section: Resultsmentioning

confidence: 89%

Comparison of the clinical effectiveness of different off‐loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta‐analysis

Morona

Buckley

Jones

et al. 2013

Diabetes Metabolism Res

115

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“…When the Active Offloading Walker was modified, the iTCC study group demonstrated a healing rate similar (86% in 12 weeks) to that in previous studies that used a traditional TCC as the off-loading treatment. There is a large body of literature that reports consistently high rates of healing (73-100%) with TCCs (Table 2) (3,4,6,7,9,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). However, because TCCs are technically difficult to use and time consuming to place, they are not widely used in most clinics worldwide.…”

Section: Results -Descriptive Characteristics Of the Populations Are mentioning

confidence: 99%

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds

et al. 2005

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OBJECTIVE -The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations. RESEARCH DESIGN AND METHODS -We randomly assigned 50 patients withUniversity of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.RESULTS -An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P ϭ 0.02, odds ratio 1.8 [95% CI 1.1Ϫ2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 Ϯ 18.7 vs. 58.0 Ϯ 15.2 days, P ϭ 0.02).CONCLUSIONS -Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds. Diabetes Care 28:551-554, 2005A melioration of pressure, shear, and repetitive injury to the sole of the foot are principal tenets of neuropathic ulcer care. Total contact casts (TCCs) are considered the gold standard in redistribution of pressure over the plantar aspect of the diabetic foot (1-7). TCCs have been shown to reduce pressure at the site of ulceration by 84 -92% (8), and there is a large body of work that supports the TCC's clinical efficacy. In two randomized controlled trials comparing the proportion of healed ulcers treated with a TCC compared with other readily available and popular devices (removable cast walkers [RCWs], half-shoes, and therapeutic depth inlay shoes) TCCs, healed a higher proportion of wounds compared with other modalities (7,9). This was an interesting finding because certain types of RCWs, including one used in one of the above-mentioned trials, often reduce pressure on the plantar aspect of the foot as well as TCCs (9). If patients do not heal as well in the RCW and yet it off-loads pressure about as well as the TCC, then a logical explanation for their less effective clinical performance is that these devices are being removed by the patients that use them (10).In an effort to make the RCW more efficacious, we have modified it slightly by merely wrapping the traditional RCW in a layer of cohesive or plaster bandage. This technique has been termed the "instant" TCC (iTCC) (11). It has been our initial experience that this technique is clinically successful. If clinical results are superior to those with the RCW, we believe it could potentially auger a significant shift in the current standard of care in pressure reduction (off-loading) of diabetic wounds. We are unaware of any reports in the literature that have compared a standard RCW with the iTCC. The purpose of this project was to evaluate the effectiveness of a traditional RCW and the iTCC to heal neuropathic foot ulcerations in pa...

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“…In two other RCTs the removable walker was made non-removable, and this approach resulted in significantly increased proportions of healed ulcers compared with the standard removable walker [80] and similar healing rates compared with the TCC [81]. A methodologically flawed RCT examined the effect of felted foam in post-operative shoes and found significantly shorter time to heal compared to a pressure relief half-shoe [82]. Healing proportions were not reported.…”

Section: Other Offloading Interventionsmentioning

confidence: 99%

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Bus

Valk

Deursen

et al. 2008

Diabetes Metab. Res. Rev.

223

182

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SummaryBackground Footwear and offloading techniques are commonly used in clinical practice for the prevention and treatment of foot ulcers in diabetes, but the evidence base to support this use is not well known. The goal of this review was to systematically assess the literature and to determine the available evidence on the use of footwear and offloading interventions for ulcer prevention, ulcer treatment, and plantar pressure reduction in the diabetic foot.

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The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers

Abstract: The felted foam technique appears to be at least as effective as conventional plantar ulcer treatment. It may be a useful alternative in treating neuropathic foot ulceration, especially in patients who are not able to avoid weight-bearing reliably.

Cited by 63 publications

References 21 publications

Comparison of the clinical effectiveness of different off‐loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta‐analysis

Comparison of the clinical effectiveness of different off‐loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta‐analysis

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

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