Offloading Strategies Used for Plantar Diabetic Foot Ulcers and Their Outcomes in Real-Life Clinical Practice

Area of Science:

• Podiatry
• Diabetology
• Wound Care

Background:

• International guidelines emphasize offloading for diabetes-related foot ulcer (DFU) healing.
• Various offloading devices are utilized in clinical settings.
• Real-world effectiveness of different offloading strategies for DFUs requires evaluation.

Purpose of the Study:

• To assess the healing effectiveness of diverse offloading devices in patients with DFUs.
• To compare outcomes across different offloading modalities in a real-life clinical context.

Main Methods:

• Retrospective cohort study involving 235 patients with plantar DFUs.
• Analysis of clinical outcomes over a 12-month follow-up period.
• Classification of patients based on offloading device type: Total Contact Cast (TCC), removable ankle-high device, custom orthopaedic shoe, bandage shoe, and felted foam.
• Univariate and multivariate analyses to evaluate ulcer-related outcomes.

Main Results:

• Bandage shoes and felted foam were frequently used, often for more severe ulcers (higher UT classification, more ulcers per foot).
• Overall healing rate at 12 weeks was 33%, with no significant difference between offloading device groups (p = 0.255).
• Healing rates at 20 weeks and 52 weeks were 51.5% and 77%, respectively.

Conclusions:

• Removable ankle-high devices, orthopaedic shoes, bandage shoes, and felted foam are common for plantar DFUs.
• Device selection appears influenced by logistical, patient, and ulcer severity factors.
• DFU healing outcomes at 12 weeks, 20 weeks, and 1 year were consistent with prior observational studies.