Rumanes Afram, van Netten Jaap J, Hutting Kor H, van Gemert-Pijnen Lisette J E W C, van Baal Jeff G
Department of Surgery, Hospital Group Twente, 7609 PP Almelo, The Netherlands.
Department of Persuasive Health Technology, University of Twente, 7522 NB Enschede, The Netherlands.
J Clin Med. 2025 May 29;14(11):3834. doi: 10.3390/jcm14113834.
International guidelines describe offloading to facilitate healing as a cornerstone in the treatment of diabetes-related foot ulcers. In present-day clinics, various offloading devices are used. The aim of this paper is to describe the effectiveness in healing of different offloading devices used in real-life clinical practice in patients with diabetes-related foot ulcers. A retrospective cohort study of 235 patients with a plantar foot ulcer in one diabetic foot centre of expertise was used. Clinical outcomes were determined during a follow-up period of 12 months. Groups were defined according to the types of offloading. Univariate and multivariate analysis was performed to assess ulcer-related outcomes in different offloading devices. Of the 235 patients, 3% were treated with a Total Contact Cast (TCC), 9% with an ankle-high removable device, 32% with a custom-made orthopaedic shoe, 16% with a bandage shoe, and 39% with felted foam. Patients who received a bandage shoe or felted foam had a higher UT classification (Stage D in 21% and 18%, respectively, = 0.001) and more ulcers per foot (13% and 5%, respectively, = 0.002). The overall healing rate at 12 weeks was 33% and was not significantly different between the offloading device groups ( = 0.255). Healing rates at 20 and 52 weeks were 51.5% and 77%. Removable ankle-high offloading devices, orthopaedic shoes, bandage shoes, and felted foam are the most frequently used for plantar diabetic foot ulcers in clinical practice. This seems to be the result of various physician- and patient-related factors such as logistical reasons, patient factors, and severity of complicated ulcers. Diabetic foot ulcer healing after 12 weeks, 20 weeks, and 1-year follow-up were consistent with previous observational studies.
国际指南将减轻负荷以促进愈合描述为糖尿病相关足部溃疡治疗的基石。在当今的诊所中，使用了各种减轻负荷的装置。本文的目的是描述在糖尿病相关足部溃疡患者的实际临床实践中使用的不同减轻负荷装置的愈合效果。我们对一个糖尿病足专业中心的235例足底溃疡患者进行了一项回顾性队列研究。在12个月的随访期内确定临床结果。根据减轻负荷的类型对组进行定义。进行单因素和多因素分析以评估不同减轻负荷装置中与溃疡相关的结果。在这235例患者中，3%接受了全接触石膏（TCC）治疗，9%接受了高帮可移除装置治疗，32%接受了定制矫形鞋治疗，16%接受了绷带鞋治疗，39%接受了毡制泡沫治疗。接受绷带鞋或毡制泡沫治疗的患者UT分级更高（分别为21%和18%处于D期，P = 0.001），每只脚的溃疡更多（分别为13%和5%，P = 0.002）。12周时的总体愈合率为33%，减轻负荷装置组之间无显著差异（P = 0.255）。20周和52周时的愈合率分别为51.5%和77%。可移除的高帮减轻负荷装置、矫形鞋、绷带鞋和毡制泡沫是临床实践中治疗足底糖尿病足溃疡最常用的方法。这似乎是由各种与医生和患者相关的因素导致的结果，如后勤原因、患者因素和复杂溃疡的严重程度。糖尿病足溃疡在12周、20周和1年随访后的愈合情况与先前的观察性研究一致。
