Multidisciplinary Offloading for Healed Diabetic Foot Ulcers: A Prospective Study on Functional Outcomes and...

Area of Science:

• Diabetology
• Podiatry
• Orthopedics

Background:

• Diabetic foot ulcers (DFUs) pose a significant risk for recurrence, amputation, and mortality.
• Effective management strategies are crucial for improving long-term outcomes in patients with healed DFUs.

Purpose of the Study:

• To compare the one-year effectiveness of multidisciplinary offloading versus standard care in preventing DFU recurrence.
• To evaluate the impact of offloading on amputation rates, mortality, and functional recovery in patients with healed DFUs.

Main Methods:

• A prospective cohort study involving 232 patients with healed DFUs, divided into a control group and an intervention group receiving various offloading modalities.
• Patient stratification considered biomechanical needs and economic feasibility for offloading device selection.
• Primary outcomes included recurrence, amputation, and mortality; secondary outcomes assessed quality of life, working ability, and ankle function.

Main Results:

• The intervention group showed significantly lower recurrence (10.9% vs. 25.0%) and mortality (3.2% vs. 14.5%) compared to the control group.
• Multivariable analysis confirmed offloading as independently protective against recurrence and mortality.
• The intervention group demonstrated superior functional recovery in quality of life, working ability, and ankle scores.

Conclusions:

• Multidisciplinary offloading is effective in reducing diabetic foot ulcer recurrence and mortality.
• Customized therapeutic footwear provides optimal biomechanical protection and functional outcomes, despite financial considerations.
• Offloading interventions significantly improve physical function and quality of life in patients with a history of DFUs.