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Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers
Örebro University Hospital. Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Örebro University, Örebro, Sweden; University Health Care Research Center, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-6410-2474
School of Health and Welfare, Jönköping University, Jönköping, Sweden.
School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia; Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia.
School of Science and Technology, Nottingham Trent University, Nottingham, UK.
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2023 (English)In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, Vol. 17, no 1, p. 99-106Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach.

PURPOSE: The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development.

METHODS: Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each individual's needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from the device to accommodate different patients' needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence.

CONCLUSIONS: By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.

Place, publisher, year, edition, pages
Diabetes Technology Society , 2023. Vol. 17, no 1, p. 99-106
Keywords [en]
casts, diabetic foot, foot ulcer, orthotic devices, shoes, treatment adherence and compliance
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-99499DOI: 10.1177/19322968221101632ISI: 000906942300012PubMedID: 35658555Scopus ID: 2-s2.0-85131536666OAI: oai:DiVA.org:oru-99499DiVA, id: diva2:1670261
Note

Funding agencies:

National Health and Medical Research Council (NHMRC) of Australia 2014165  

Urgo Foundation

Available from: 2022-06-15 Created: 2022-06-15 Last updated: 2023-01-31Bibliographically approved

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Jarl, Gustav

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