TY - JOUR
T1 - The management of diabetic foot ulcers through optimal off-loading
T2 - Building consensus guidelines and practical recommendations to improve outcomes
AU - Snyder, Robert J.
AU - Frykberg, Robert G.
AU - Rogers, Lee C.
AU - Applewhite, Andrew J.
AU - Bell, Desmond
AU - Bohn, Gregory
AU - Fife, Caroline E.
AU - Jensen, Jeffrey
AU - Wilcox, James
N1 - Publisher Copyright:
© 2014, American Podiatric Medical Association, Inc.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Background: We sought to develop a consensus statement for the use of off-loading in the management of diabetic foot ulcers (DFUs).Methods: A literature search of PubMed for evidence regarding off-loading of DFUs was initially conducted, followed by a meeting of authors on March 15, 2013, in Philadelphia, Pennsylvania, to draft consensus statements and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess quality of evidence and develop strength of recommendations for each consensus statement.Results: Evidence is clear that adequate off-loading increases the likelihood of DFU healing and that increased clinician use of effective off-loading is necessary. Recommendations are included to guide clinicians on the optimal use of off-loading based on an initial comprehensive patient/wound assessment and the necessity to improve patient adherence with off-loading devices.Conclusions: The likelihood of DFU healing is increased with off-loading adherence, and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities. There currently exists a gap between what the evidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care.
AB - Background: We sought to develop a consensus statement for the use of off-loading in the management of diabetic foot ulcers (DFUs).Methods: A literature search of PubMed for evidence regarding off-loading of DFUs was initially conducted, followed by a meeting of authors on March 15, 2013, in Philadelphia, Pennsylvania, to draft consensus statements and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess quality of evidence and develop strength of recommendations for each consensus statement.Results: Evidence is clear that adequate off-loading increases the likelihood of DFU healing and that increased clinician use of effective off-loading is necessary. Recommendations are included to guide clinicians on the optimal use of off-loading based on an initial comprehensive patient/wound assessment and the necessity to improve patient adherence with off-loading devices.Conclusions: The likelihood of DFU healing is increased with off-loading adherence, and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities. There currently exists a gap between what the evidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care.
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U2 - 10.7547/8750-7315-104.6.555
DO - 10.7547/8750-7315-104.6.555
M3 - Article
C2 - 25514266
AN - SCOPUS:84918574201
SN - 8750-7315
VL - 104
SP - 555
EP - 567
JO - Journal of the American Podiatric Medical Association
JF - Journal of the American Podiatric Medical Association
IS - 6
ER -