The DOI matches its Crossref record; 59 of the 60 references it cites were found in a registry or an index.
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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Prompers, L., Huijberts, M., Apelqvist, J., Jude, E., Piaggesi, A., Bakker, K., Edmonds, M., Holstein, P., Jirkovska, A., Mauricio, D., et al. (2007) · Diabetologia · doi:10.1007/s00125-006-0491-1 · Cited by 1,023
Off-Loading the Diabetic Foot Wound
Armstrong, D. G., Nguyen, H. C., Lavery, L. A., van Schie, C. H. M., Boulton, A. J. M., & Harkless, L. B. (2001) · Diabetes Care · doi:10.2337/diacare.24.6.1019 · Cited by 602
Treatment for diabetic foot ulcers
Cavanagh, P. R., Lipsky, B. A., Bradbury, A. W., & Botek, G. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67699-4 · Cited by 551
Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review
van Netten, J. J., Price, P., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y., Bus, S. A., & on behalf of the International Working Group on the Diabetic Foot (IWGDF) (2015) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2701 · Cited by 426
IWGDF guidance on the prevention of foot ulcers in at‐risk patients with diabetes
Bus, S. A., van Netten, J. J., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y., Price, P., & on behalf of the International Working Group on the Diabetic Foot (IWGDF) (2015) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2696 · Cited by 349
Predictive factors for diabetic foot ulceration: a systematic review
Monteiro‐Soares, M., Boyko, E. J., Ribeiro, J. L. D. C., Ribeiro, I., & Dinis-Ribeiro, M. J. (2012) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2319 · Cited by 323
Effect of Custom-Made Footwear on Foot Ulcer Recurrence in Diabetes
Bus, S. A., Waaijman, R., Arts, M. L. J., de Haart, M., Busch‐Westbroek, T. E., Baal, J. V., & Nollet, F. (2013) · Diabetes Care · doi:10.2337/dc13-0996 · Cited by 314
Bus, S. A., Deursen, R. W. M. V., Armstrong, D. G., Lewis, J. E. A., Caravaggi, C., Cavanagh, P. R., & on behalf of the International Working Group on the Diabetic Foot (IWGDF) (2015) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2702 · Cited by 312
Activity Patterns of Patients With Diabetic Foot Ulceration
Armstrong, D. G., Lavery, L. A., Kimbriel, H. R., Nixon, B. P., & Boulton, A. J. M. (2003) · Diabetes Care · doi:10.2337/diacare.26.9.2595 · Cited by 306
Bus, S. A., Ulbrecht, J. S., & Cavanagh, P. R. (2004) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2004.02.010 · Cited by 289
Cited by
Sorted by citations
Diabetic foot ulcers and their recurrence
Armstrong, D. G., Boulton, A. J. M., & Bus, S. A. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1615439 · Cited by 4,376
Diabetic Foot Ulcers: A Review
Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023) · JAMA · doi:10.1001/jama.2023.10578 · Cited by 1,928
Self-citationUpdate on management of diabetic foot ulcers
Everett, E. M., & Mathioudakis, N. N. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13569 · Cited by 993
Akkuş, G., & Sert, M. (2022) · World Journal of Diabetes · doi:10.4239/wjd.v13.i12.1106 · Cited by 287
Evaluation and Management of Lower-Extremity Ulcers
Singer, A. J., Tassiopoulos, A. K., & Kirsner, R. S. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1615243 · Cited by 231
Metadata
- 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 › Surgery › 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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