{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T18:39:05Z","timestamp":1791052745524,"version":"4.1.0"},"reference-count":150,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T00:00:00Z","timestamp":1584316800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Offloading interventions are commonly used in clinical practice to heal foot ulcers. The aim of this updated systematic review is to investigate the effectiveness of offloading interventions to heal diabetic foot ulcers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We updated our previous systematic review search of PubMed, EMBASE, and Cochrane databases to also include original studies published between July 29, 2014 and August 13, 2018 relating to four offloading intervention categories in populations with diabetic foot ulcers: (a) offloading devices, (b) footwear, (c) other offloading techniques, and (d) surgical offloading techniques. Outcomes included ulcer healing, plantar pressure, ambulatory activity, adherence, adverse events, patient\u2010reported measures, and cost\u2010effectiveness. Included controlled studies were assessed for methodological quality and had key data extracted into evidence and risk of bias tables. Included non\u2010controlled studies were summarised on a narrative basis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 41 studies from our updated search for a total of 165 included studies. Six included studies were meta\u2010analyses, 26 randomised controlled trials (RCTs), 13 other controlled studies, and 120 non\u2010controlled studies. Five meta\u2010analyses and 12 RCTs provided high\u2010quality evidence for non\u2010removable knee\u2010high offloading devices being more effective than removable offloading devices and therapeutic footwear for healing plantar forefoot and midfoot ulcers. Total contact casts (TCCs) and non\u2010removable knee\u2010high walkers were shown to be equally effective. Moderate\u2010quality evidence exists for removable knee\u2010high and ankle\u2010high offloading devices being equally effective in healing, but knee\u2010high devices have a larger effect on reducing plantar pressure and ambulatory activity. Low\u2010quality evidence exists for the use of felted foam and surgical offloading to promote healing of plantar forefoot and midfoot ulcers. Very limited evidence exists for the efficacy of any offloading intervention for healing plantar heel ulcers, non\u2010plantar ulcers, and neuropathic ulcers with infection or ischemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Strong evidence supports the use of non\u2010removable knee\u2010high offloading devices (either TCC or non\u2010removable walker) as the first\u2010choice offloading intervention for healing plantar neuropathic forefoot and midfoot ulcers. Removable offloading devices, either knee\u2010high or ankle\u2010high, are preferred as second choice over other offloading interventions. The evidence bases to support any other offloading intervention is still weak and more high\u2010quality controlled studies are needed in these areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3275","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T09:07:41Z","timestamp":1584349661000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":104,"title":["Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-7964","authenticated-orcid":false,"given":"Peter A.","family":"Lazzarini","sequence":"first","affiliation":[{"name":"School of Public Health and Social Work Queensland University of Technology  Brisbane Queensland Australia"},{"name":"Allied Health Research Collaborative The Prince Charles Hospital  Brisbane Queensland 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