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The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non\u2010controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included two systematic reviews and meta\u2010analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non\u2010controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta\u2010analyses show non\u2010removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sufficient evidence of good quality supports the use of non\u2010removable offloading to heal plantar neuropathic forefoot ulcers and therapeutic footwear with demonstrated pressure relief that is worn by the patient to prevent plantar foot ulcer recurrence. The evidence base to support the use of other offloading interventions is still limited and of variable quality. The evidence for the use of interventions to prevent a first foot ulcer or heal ischemic, infected, non\u2010plantar, or proximal foot ulcers is practically non\u2010existent. High\u2010quality controlled studies are needed in these areas.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.2702","type":"journal-article","created":{"date-parts":[[2015,9,5]],"date-time":"2015-09-05T13:58:35Z","timestamp":1441461515000},"page":"99-118","source":"Crossref","is-referenced-by-count":256,"title":["Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review"],"prefix":"10.1002","volume":"32","author":[{"given":"S. A.","family":"Bus","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Academic Medical Centre University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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