Offloading for the Treatment of the Diabetic Foot - A Systematic Review

Aim: To compare the strengths and limitations of different offloading devices in the treatment of diabetic foot ulcers.

Method: Systematic review.

Background: Diabetes is a chronic disease where neuropathy and peripheral vascular disease, associated with foot deformity, trauma and high plantar pressures contribute to the development of foot ulceration. For those with existing ulcers, if the foot is subject to continuous high pressures, tissue damage persists and healing will be impaired. Therefore, the use of offloading devices becomes fundamental for the treatment of these ulcers.

Findings: Following a systematic search of the literature, 14 studies were included in this review. Healing rates, healing times and reduction in ulcer size were improved with the use of total contact casting, compared with other offloading devices. The main adverse effects associated with use of the device were infection, maceration and abrasion. Cost, compliance and quality of life issues were rarely included within the studies.

Conclusion: Offloading is a key treatment strategy for the management of diabetic foot ulceration and total contact casts were found to be the most effective devices to achieve ulcer healing. However, they are not without complications and further, their impact on cost, compliance and quality of life is not well understood.