A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers.
Open accessAbstract
BACKGROUND: Offloading is key to preventing or healing plantar neuropathic foot ulcers in diabetes. Total contact casts or walkers rendered irremovable are recommended in guidelines as first-line options for offloading, however the use of such devices has been found to be low. This study aimed to investigate offloading practices for diabetes-related plantar neuropathic ulcers. METHODS: An online survey of closed and open-ended questions was administered via SurveyMonkey®. Forty-one podiatrists experienced in high-risk foot practice, from 21 high-risk foot services around Australia, were approached to participate. RESULTS: The response rate was 88%. Participants reported using 21 modalities or combinations of modalities, for offloading this ulcer type. The most frequently used modalities under the forefoot and hallux were felt padding, followed by removable casts or walkers, then non-removable casts or walkers. Participants indicated that many factors were considered when selecting offloading modality, including: compliance, risk of adverse effects, psycho-social factors, restrictions on activities of daily living, work needs and features of the wound. The majority of participants (83%) considered non-removable casts or walkers to be the gold-standard for offloading this ulcer type, however they reported numerous, particularly patient-related, barriers to their use. CONCLUSIONS: Selecting offloading for the management of foot ulceration is complex. Felt padding, not the gold-standard non-removable cast or walker, was reported as the most commonly selected modality for offloading plantar neuropathic ulceration. However, further evaluation of felt padding in high quality clinical trials is required to ascertain its effectiveness for ulcer healing.
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Although guidelines recommend regular debridement, defined as weekly or every other week, randomized clinical trials are lacking.
“Although guidelines recommend regular debridement, defined as weekly or every other week, randomized clinical trials are lacking.52,53”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Conclusions discuss a need for randomized trials of felt-padding offloading, not debridement. Searches for debridement and the claimed weekly or every-other-week schedule found no passage in our copy addressing those points or a lack of debridement trials. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSeveral new topical therapies have been shown to accelerate wound healing in multicenter randomized clinical trials.
“Several new topical therapies have been shown to accelerate wound healing in multicenter randomized clinical trials.52”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Background and Conclusions discuss faster healing with pressure-offloading devices, not new topical therapies. The Discussion describes limited trial evidence for felt padding. Searches for topical therapies and multicenter randomized trials found no passage addressing the attributed claim; page numbers were unavailable in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredFew data are available regarding the optimal wound dressing for diabetic foot ulcers.
“Wound Dressings |: Few data are available regarding the optimal wound dressing for diabetic foot ulcers.52,62”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Background and Discussion address evidence for offloading devices and felt padding, not evidence for choosing an optimal wound dressing. A search for wound dressings found only a mention of difficulty with dressing changes; our copy does not address the claimed lack of dressing data. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDebridement is a standardized approach used to facilitate healing.
“Debridement |: Debridement is a standardized approach used to facilitate healing.52”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Background and Results discuss offloading to promote healing of diabetic foot ulcers, not debridement. A search of our full-text copy for “debridement” found no passage addressing whether it is a standardized approach used to facilitate healing. (LLM, conf=0.77)
Experimental — accuracy not yet measuredTopical oxygen as an adjunct therapy in diabetic foot ulcers may be considered when standard of care alone has failed (<50% of ulcer healed at 4 weeks), based on recent meta-analyses of randomized clinical trials and systematic reviews.
“Topical oxygen as an adjunct therapy in diabetic foot ulcers may be considered when standard of care alone has failed (<50% of ulcer healed at 4 weeks), based on recent meta-analyses of randomized clinical trials and systematic reviews.52,72”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Background and Conclusions (page not provided) discuss offloading devices and felt padding, not topical oxygen. Searches for topical oxygen and the <50% healing threshold at four weeks found no passage addressing either point or the claimed recommendation. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Negative pressure wound therapy has been widely used as an adjunct therapy in the treatment of complicated and postoperative wounds in the diabetic foot for the last 2 decades.
“Negative pressure wound therapy has been widely used as an adjunct therapy in the treatment of complicated and postoperative wounds in the diabetic foot for the last 2 decades. 52,64”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Background and Conclusions discuss pressure offloading for diabetic foot ulcers, not negative pressure wound therapy. Searches for that term and for vacuum-assisted closure found no passage addressing its use for complicated or postoperative wounds or the claimed two-decade history. (LLM, conf=0.77)
Experimental — accuracy not yet measuredMore recent trials did not show a significant effect of hyperbaric oxygen therapy.
“but more recent trials did not show a significant effect of hyperbaric oxygen therapy.52,71”
From Diabetic Foot Ulcers (2023) · cites this paper as [52]
The Background and Conclusions discuss pressure offloading and ulcer healing, not hyperbaric oxygen therapy. Searches for “hyperbaric oxygen therapy” and “hyperbaric oxygen” found no passage addressing whether recent trials showed a significant effect. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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Cites
Three Approaches to Qualitative Content Analysis
Hsieh, H.-F., & Shannon, S. E. (2005) · Qualitative Health Research · doi:10.1177/1049732305276687 · Cited by 44,601 · see citing works
Pathways to Diabetic Limb Amputation: Basis for Prevention
Pecoraro, R. E., Reiber, G. E., & Burgess, E. M. (1990) · Diabetes Care · doi:10.2337/diacare.13.5.513 · Cited by 1,585 · see citing works
The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study
Veves, A., Murray, H. J., Young, M. J., & Boulton, A. J. M. (1992) · Diabetologia · doi:10.1007/bf00400259 · Cited by 709 · see citing works
Pham, H., Armstrong, D. G., Harvey, C., Harkless, L. B., Giurini, J. M., & Veves, A. (2000) · Diabetes Care · doi:10.2337/diacare.23.5.606 · Cited by 654 · see citing works
Role of Neuropathy and High Foot Pressures in Diabetic Foot Ulceration
Frykberg, R. G., Lavery, L. A., Pham, H., Harvey, C., Harkless, L. B., & Veves, A. (1998) · Diabetes Care · doi:10.2337/diacare.21.10.1714 · Cited by 464 · see citing works
Bus, S. A., Valk, G. D., Deursen, R. W. M. V., Armstrong, D. G., Caravaggi, C. M. F., Hlaváček, P., Bakker, K., & Cavanagh, P. R. (2008) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.850 · Cited by 269 · see citing works
Use of Pressure Offloading Devices in Diabetic Foot Ulcers
Wu, S. C., Jensen, J. L., Weber, A. K., Robinson, D. E., & Armstrong, D. G. (2008) · Diabetes Care · doi:10.2337/dc08-0771 · Cited by 207 · see citing works
Prompers, L., Huijberts, M. S., Apelqvist, J., Jude, E. B., Piaggesi, A., Bakker, K., Edmonds, M. E., Holstein, P., Jirkovská, A., Mauricio, D., et al. (2008) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02445.x · Cited by 203 · see citing works
Off-loading the diabetic foot for ulcer prevention and healing
Cavanagh, P. R., & Bus, S. A. (2010) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2010.06.007 · Cited by 170 · see citing works
Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy
Klaesner, J. W., Hastings, M. K., Zou, D., Lewis, C. L., & Mueller, M. J. (2002) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2002.35661 · Cited by 154 · see citing works
Pressure-relieving interventions for treating diabetic foot ulcers
Lewis, J., & Lipp, A. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002302.pub2 · Cited by 121 · see citing works
Priorities in offloading the diabetic foot
Bus, S. A. (2012) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2240 · Cited by 95 · see citing works
Why is it so hard to do the right thing in wound care?
Fife, C. E., Carter, M. J., & Walker, D. (2010) · Wound Repair and Regeneration · doi:10.1111/j.1524-475x.2010.00571.x · Cited by 87 · see citing works
Australian Diabetes Foot Network: management of diabetes‐related foot ulceration — a clinical update
Bergin, S. M., Gurr, J. M., Allard, B. P., et al. (2012) · The Medical Journal of Australia · doi:10.5694/mja11.10347 · Cited by 47 · see citing works
Nubé, V. L., Molyneaux, L. M., Bolton, T., Clingan, T., Palmer, E., & Yue, D. K. (2006) · The Foot · doi:10.1016/j.foot.2005.11.005 · Cited by 32 · see citing works
Veves, A., Murray, H. J., Young, M., et al. (1991) · Clinical Science · doi:10.1042/cs081028pb · Cited by 32 · see citing works
Zimny, S., Meyer, M., Schatz, H., et al. (2002) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-2002-34988 · Cited by 24 · see citing works
Do We Practice What We Preach?
Day, N. E., & Peluchette, J. V. (2008) · Journal of Leadership & Organizational Studies · doi:10.1177/1548051808326035 · Cited by 10 · see citing works
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Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023) · JAMA · doi:10.1001/jama.2023.10578 · Cited by 1,658 · see citing works
Guidelines on offloading foot ulcers in persons with diabetes—IWGDF 2023 update.
Bus, S. A., Armstrong, D. G., Crews, R. T., Gooday, C., Jarl, G., Kirketerp‐Moller, K., Viswanathan, V., & Lazzarini, P. A. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3647 · Cited by 169 · see citing works
The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence.
Bus, S. A. (2016) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000002686 · Cited by 118 · see citing works
- Authors
- Raspovic, A., & Landorf, K. B.
- Affiliations
- La Trobe University (AU)
- Corresponding author
- Raspovic, Anita
- Venue
- Journal of Foot and Ankle Research
- Publisher
- Wiley
- Published
- 2014-01
- Volume
- 7
- Issue
- 1
- Pages
- 35-35
- ISSN
- 1757-1146 (ISSN-L)
- PMC
- PMC4332025
- OpenAlex
- W2104146718
- Cited by
- 58
- References
- 18
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2023: 11 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 7 · 2015: 1
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- creativecommons.org/licenses/by/4.0),%20which%20permits%20unrestricted%20use,%20distribution,%20and%20reproduction%20in%20any%20medium,%20provided%20the%20original%20work%20is%20properly%20credited.%20The%20Creative%20Commons%20Public%20Domain%20Dedication%20waiver%20(http://creativecommons.org/publicdomain/zero/1.0/ (vor, 224 d)
- creativecommons.org/licenses/by/4.0 (unspecified)
- Locations
- Journal of Foot and Ankle Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- La Trobe University (cc-by)
- Funders
- La Trobe University
- 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
- offloading, diabetic foot, total contact cast, podiatrists, barriers to treatment, ulcer healing
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