Bus S A, Valk G D, van Deursen R W, Armstrong D G, Caravaggi C, Hlavácek P, Bakker K, Cavanagh P R
Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S162-80. doi: 10.1002/dmrr.850.
Footwear and offloading techniques are commonly used in clinical practice for the prevention and treatment of foot ulcers in diabetes, but the evidence base to support this use is not well known. The goal of this review was to systematically assess the literature and to determine the available evidence on the use of footwear and offloading interventions for ulcer prevention, ulcer treatment, and plantar pressure reduction in the diabetic foot.
A search was made for reports on the effectiveness of footwear and offloading interventions in preventing or healing foot ulcers or reducing plantar foot pressure in diabetic patients published prior to May 2006. Both controlled and uncontrolled studies were included. Assessment of the methodological quality of studies and data extraction was independently performed by two reviewers. Interventions were assigned into four subcategories: casting, footwear, surgical offloading and other offloading techniques.
Of 1651 articles identified in the baseline search, 21 controlled studies were selected for grading following full text review. Another 108 uncontrolled and cross-sectional studies were examined. The evidence to support the use of footwear and surgical interventions for the prevention of ulceration is meagre. Evidence was found to support the use of total contact casts and other non-removable modalities for treatment of neuropathic plantar ulcers. More studies are needed to support the use of surgical offloading techniques for ulcer healing. Plantar pressure reduction can be achieved by several modalities including casts, walkers, and therapeutic footwear, but the diversity in methods and materials used limits the comparison of study results.
This systematic review provides support for the use of non-removable devices for healing plantar foot ulcers. Furthermore, more high-quality studies are urgently needed to confirm the promising effects found in both controlled and uncontrolled studies of footwear and offloading interventions designed to prevent ulcers, heal ulcers, or reduce plantar pressure.
鞋具及减压技术在临床实践中常用于预防和治疗糖尿病足溃疡，但支持其应用的证据基础尚不为人熟知。本综述的目的是系统评估文献，并确定关于使用鞋具及减压干预措施预防溃疡、治疗溃疡以及降低糖尿病足足底压力的现有证据。
检索2006年5月之前发表的关于鞋具及减压干预措施在预防或治愈糖尿病患者足部溃疡或降低足底压力方面有效性的报告。纳入了对照研究和非对照研究。两名评审员独立进行研究方法学质量评估和数据提取。干预措施分为四个子类别：石膏固定、鞋具、手术减压和其他减压技术。
在基线检索中识别出的1651篇文章中，经过全文评审后选择了21项对照研究进行分级。另外审查了108项非对照研究和横断面研究。支持使用鞋具和手术干预措施预防溃疡的证据不足。发现有证据支持使用全接触石膏及其他不可拆卸方式治疗神经性足底溃疡。需要更多研究来支持使用手术减压技术促进溃疡愈合。通过包括石膏固定、助行器和治疗性鞋具在内的多种方式可实现足底压力降低，但所使用方法和材料的多样性限制了研究结果的比较。
本系统综述为使用不可拆卸装置治疗足底溃疡提供了支持。此外，迫切需要更多高质量研究来证实鞋具及减压干预措施在对照研究和非对照研究中发现的预防溃疡、治愈溃疡或降低足底压力的潜在效果。
