The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence.
Open accessAbstract
BACKGROUND: An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. METHODS: In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence. RESULTS: Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading. Recent meta-analyses and systematic reviews show that nonremovable knee-high devices are most effective. This is probably because they eliminate the problem of nonadherence with the use of a removable device. Studies show a large discrepancy between evidence-based recommendations on offloading and what is used in clinical practice. Many clinics continue to use methods that are less effective or have not been proven to be effective, while ignoring evidence-based methods. Strategies are proposed to address this issue, notably the adoption and implementation of recent international guidelines by professional societies and a stronger focus of clinicians on expedited healing. For the prevention of plantar foot ulcer recurrence in high-risk patients, 2 recent trials have shown that the incidence of recurrence can be significantly reduced with custom-made footwear that has a demonstrated pressure-relieving effect through guidance by plantar pressure measurements, under the condition that the footwear is worn. CONCLUSION: This review helps to inform clinicians about effective offloading treatment for healing plantar foot ulcers and preventing their recurrence.
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- Authors
- Bus, S. A.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Bus, Sicco A.
- ORCID
- Bus, Sicco A.
- Venue
- Plastic & Reconstructive Surgery
- Published
- 2016-09
- Volume
- 138
- Issue
- 3S
- Pages
- 179S-187S
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2512750658
- Cited by
- 118
- References
- 60
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 18 · 2023: 20 · 2022: 24 · 2021: 13 · 2020: 11 · 2019: 8 · 2018: 7 · 2017: 5 · 2016: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Keywords
- diabetic foot ulcer, pressure offloading, plantar pressure, ulcer healing, ulcer recurrence prevention, plantar pressure measurement, diabetic neuropathy, lower extremity amputation prevention, evidence-based practice
- MeSH terms
- Foot, Humans, Pressure, Recurrence, Wound Healing, Weight-Bearing, Treatment Outcome, Diabetic Foot, Secondary Prevention, Foot Orthoses
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