Basic Low-cost Removable Footwear for Diabetic Foot Ulcer Offloading: A Systematic Review

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.