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Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?

Wu SC, Jensen JL, Weber AK, Robinson DE, Armstrong DG - Diabetes Care (2008)

Bottom Line: We therefore discuss characteristics and considerations associated with the use of offloading devices.A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005.A total of 901 geographically diverse centers responded.

View Article: PubMed Central - PubMed

Affiliation: Scholl's Center for Lower-Extremity Ambulatory Research, Rosalind Franklin Universityof Medicine and Science, North Chicago, Illinois, USA. stephanie.wu@rosalindfranklin.edu

ABSTRACT

Objective: Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices.

Research design and methods: A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of diabetic foot ulcers in each center.

Results: Of the 895 respondents who treat diabetic foot ulcers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation, whereas total contact casts were used by only 1.7% of the centers.

Conclusions: This study reports the usage and characteristics of offloading devices in the care of diabetic foot ulcers in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the "gold standard" (total contact cast) for treating the majority of diabetic foot ulcers.

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Type and frequency of plantar offloading used across 895 clinics.
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f1: Type and frequency of plantar offloading used across 895 clinics.

Mentions: Of the 901 respondents, 895 centers actively treated diabetic foot ulcers. The type and frequency of plantar offloading used is summarized in Figure 1. Of the 895 centers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation in >51% of diabetic foot ulcer treatments. There were no significant regional differences in therapy. Total contact casts (TCCs) were used by only 1.7% of the centers for the majority of diabetic foot ulcer treatment, whereas 15.2% of the centers reported use of removable cast walkers. A total of 2.6% of the centers reported application of other modalities such as therapeutic shoes, and 12.3% of the centers reported use of complete non–weight-bearing (NWB) strategies such as crutches and wheelchairs for the majority of treatment. A total of 58.1% (520 centers) did not consider TCCs as the gold standard to offload the noninfected plantar diabetic foot ulcers. A total of 45.5% of the centers nationwide reported no use of TCCs as an offloading modality. Commonly reported factors affecting frequency of TCC usage included patient tolerance (55.3%), the time needed to apply the cast (54.3%), cost of materials (31.6%), reimbursement issues (27.5%), familiarity with method of application (25%), customizing parts (20.9%), staffing/ordering supplies (15.2%), and clinician coverage (10.6%).


Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?

Wu SC, Jensen JL, Weber AK, Robinson DE, Armstrong DG - Diabetes Care (2008)

Type and frequency of plantar offloading used across 895 clinics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571059&req=5

f1: Type and frequency of plantar offloading used across 895 clinics.
Mentions: Of the 901 respondents, 895 centers actively treated diabetic foot ulcers. The type and frequency of plantar offloading used is summarized in Figure 1. Of the 895 centers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation in >51% of diabetic foot ulcer treatments. There were no significant regional differences in therapy. Total contact casts (TCCs) were used by only 1.7% of the centers for the majority of diabetic foot ulcer treatment, whereas 15.2% of the centers reported use of removable cast walkers. A total of 2.6% of the centers reported application of other modalities such as therapeutic shoes, and 12.3% of the centers reported use of complete non–weight-bearing (NWB) strategies such as crutches and wheelchairs for the majority of treatment. A total of 58.1% (520 centers) did not consider TCCs as the gold standard to offload the noninfected plantar diabetic foot ulcers. A total of 45.5% of the centers nationwide reported no use of TCCs as an offloading modality. Commonly reported factors affecting frequency of TCC usage included patient tolerance (55.3%), the time needed to apply the cast (54.3%), cost of materials (31.6%), reimbursement issues (27.5%), familiarity with method of application (25%), customizing parts (20.9%), staffing/ordering supplies (15.2%), and clinician coverage (10.6%).

Bottom Line: We therefore discuss characteristics and considerations associated with the use of offloading devices.A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005.A total of 901 geographically diverse centers responded.

View Article: PubMed Central - PubMed

Affiliation: Scholl's Center for Lower-Extremity Ambulatory Research, Rosalind Franklin Universityof Medicine and Science, North Chicago, Illinois, USA. stephanie.wu@rosalindfranklin.edu

ABSTRACT

Objective: Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices.

Research design and methods: A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of diabetic foot ulcers in each center.

Results: Of the 895 respondents who treat diabetic foot ulcers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation, whereas total contact casts were used by only 1.7% of the centers.

Conclusions: This study reports the usage and characteristics of offloading devices in the care of diabetic foot ulcers in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the "gold standard" (total contact cast) for treating the majority of diabetic foot ulcers.

Show MeSH
Related in: MedlinePlus