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The levels of care describe the services provided in the healthcare system. Accordingly, there are six levels of the traditional healthcare system in the US: preventive, primary, secondary, tertiary, restorative, and continuing healthcare. A nurse must understand how the healthcare industry organizes and provides services within these levels of care.
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Basic Low-cost Removable Footwear for Diabetic Foot Ulcer Offloading: A Systematic Review.

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  • 1Medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

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Summary
This summary is machine-generated.

Removable offloading footwear offers a practical, low-cost option for diabetic foot ulcer (DFU) prevention and healing. While not superior to total contact casts, these devices provide moderate utility for patients unable to tolerate TCCs or in resource-limited settings.

Keywords:
diabetic foot ulcerevidence-basedinsolesoffloadingremovable footwearsystematic reviewtherapeutic footwear

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Area of Science:

  • Podiatry
  • Diabetology
  • Wound Care

Background:

  • Diabetic foot ulcers (DFUs) require offloading to reduce plantar pressure, promote healing, and prevent recurrence.
  • The irremovable total contact cast (TCC) is the gold standard but presents challenges in application and patient adherence.
  • Accessible and removable offloading footwear presents an alternative for DFU management.

Purpose of the Study:

  • To systematically review the efficacy of removable offloading footwear for DFU healing, prevention, and recurrence.
  • To evaluate the utility of accessible and removable offloading devices in various clinical scenarios.

Main Methods:

  • A systematic literature search of MEDLINE and Embase was conducted on July 25, 2023.
  • Studies reporting on patients with DFU treated with removable offloading devices were included after title, abstract, and full-text screening.
  • Data on patient demographics, healing time, amputation rates, and recurrence were extracted and pooled.

Main Results:

  • A mean healing rate of 71% was observed in 618 cases with active ulcers, with a mean healing time of 68.4 days.
  • The mean amputation rate was 15.4%, and the mean recurrence rate was 22.5% over a 39.7-month follow-up in 760 cases.
  • The incidence rate of new DFUs was 2% in 316 cases evaluated for prevention.

Conclusions:

  • Simple, removable offloading devices are a potentially accessible and cost-effective option for DFU prevention and recurrence management.
  • Outcomes for healing and amputation were comparable to existing literature on TCCs, suggesting moderate utility.
  • Removable footwear may be particularly beneficial for patients who cannot tolerate TCCs or in low-resource healthcare settings.