Clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers

NewsBot · Oct 1, 2024

Offloading systems for the treatment of neuropathic foot ulcers in patients with diabetes mellitus: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome
Carlotta Gauna, Francesco Romeo, Alessia Scatena, Cesare Miranda, Luigi Uccioli, Cristiana Vermigli, Antonio Volpe, Corrado Bordieri, Rodolfo Tramonta, Benedetta Ragghianti, Giulia Bandini, Matteo Monami & Luca Monge for the Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome* and on behalf of SID and AMD
15 March 2024

To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome.

Methods
The present MA includes randomized controlled studies (duration > 12 weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing.

Results
A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p = 0.04, I2 = 0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p = 0.002, I2 = 51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p = 0.008, I2 = 0%).

Conclusions
Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary.
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Clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers

NewsBot The Admin that posts the news.

The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg,

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Share This Page

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