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Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)
Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, California, US.
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, Norwich, UK; School of Health Sciences, University of East Anglia, Norwich, UK.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-6410-2474
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2020 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 36, no Suppl 1, article id e3274Article in journal (Refereed) Published
Abstract [en]

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee-high offloading device is the first choice of offloading treatment. A removable knee-high and removable ankle-high offloading device are to be considered as the second- and third-choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth-choice offloading treatment. If non-surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020. Vol. 36, no Suppl 1, article id e3274
Keywords [en]
Cast, diabetic foot, foot ulcer, footwear, guidelines, offloading, surgery
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-80913DOI: 10.1002/dmrr.3274ISI: 000559257300026PubMedID: 32176441Scopus ID: 2-s2.0-85081900932OAI: oai:DiVA.org:oru-80913DiVA, id: diva2:1417761
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2020-12-01Bibliographically approved

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Jarl, Gustav

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