{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:37:52Z","timestamp":1779917872505,"version":"3.53.1"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to assess (1) the use of different offloading interventions in Sweden for the healing of diabetes\u2010related plantar neuropathic forefoot ulcers, (2) factors influencing the offloading intervention choice, and (3) the awareness of current gold standard offloading devices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An online questionnaire was distributed via SurveyMonkey to 51 prosthetic and orthotic clinics in Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010five (69%) practitioners responded to the questionnaire. Eighty\u2010six percent of the practitioners provided modified off\u2010the\u2010shelf footwear combined with insoles to treat diabetes\u2010related plantar neuropathic forefoot ulcers. A total contact cast (TCC) was provided by 20% of the practitioners, and a nonremovable knee\u2010high walker was provided by 0%. Multiple practitioner\u2010, patient\u2010, intervention\u2010, and wound\u2010related factors were considered when practitioners provided offloading interventions to patients with this type of ulcer. The majority of the practitioners did not or were unsure whether they considered TCC or a nonremovable knee\u2010high walker to be the gold standard treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Practitioners mainly provided the offloading intervention that the International Working Group on the Diabetic Foot strongly recommends not be provided, namely, modified off\u2010the\u2010shelf footwear with insoles. In contrast, TCC and nonremovable knee\u2010high walkers, as the gold standards, were vastly underutilised. Therefore, the pattern of providing offloading interventions was almost exactly opposite to the recommendations of evidence\u2010based guidelines. Different factors were considered when providing offloading interventions to patients with diabetes\u2010related plantar neuropathic forefoot ulcers. The practitioners' lack of awareness regarding gold standard devices may have contributed to the underutilisation of TCC and nonremovable knee\u2010high walkers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3611","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T23:24:34Z","timestamp":1674084274000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Offloading of diabetes\u2010related neuropathic foot ulcers at Swedish prosthetic and orthotic clinics"],"prefix":"10.1002","volume":"39","author":[{"given":"Isabella","family":"Gigante","sequence":"first","affiliation":[{"name":"The Department of Orthopaedics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elva Dr\u00f6fn","family":"Sigurj\u00f3nsd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Department of Prosthetics and Orthotics Sto\u00f0  Hafnarfj\u00f6r\u00f0ur Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6410-2474","authenticated-orcid":false,"given":"Gustav","family":"Jarl","sequence":"additional","affiliation":[{"name":"Department of Prosthetics and Orthotics Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro Sweden"},{"name":"University Health Care Research Center Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4278-0941","authenticated-orcid":false,"given":"Ulla","family":"Hellstrand\u00a0Tang","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"The Department of Prosthetics and Orthotics Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1615439"},{"key":"e_1_2_14_3_1","unstructured":"Swedeamp.Amputations\u2010Och Protesregister F\u00f6r Nedre Extremiteten: \u00c5rsrapport 2019(Amputation and prosthesis register for the lower extremity: annual report 2019) [cited 2021 16th of June].https:\/\/swedeamp.com\/wp\u2010content\/uploads\/2020\/08\/Arsrapport\u20102019_FINAL_0820.pdf"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3274"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2014.04.005"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053\u2010200018030\u201000003"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136\u2010018\u20102082\u20102"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010020\u201005277\u20103"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010014\u20100035\u20108"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08\u20100771"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2008.02445.x"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.02.003"},{"key":"e_1_2_14_14_1","volume-title":"Process of Translation and Adaptation of Instruments","author":"World Health Organization","year":"2021"},{"key":"e_1_2_14_15_1","unstructured":"National Board of Health and Welfare.Nationella Riktlinjer F\u00f6r Diabetesv\u00e5rd (National Guidlines for Diabetes Care);2021. [updated October 2018; cited 2021 5 January]https:\/\/www.socialstyrelsen.se\/globalassets\/sharepoint\u2010dokument\/artikelkatalog\/nationella\u2010riktlinjer\/2018\u201010\u201025.pdf"},{"key":"e_1_2_14_16_1","doi-asserted-by":"crossref","unstructured":"ErasmusA MelekM HoM.Preferred Offloading Modalities for Management of Diabetic Foot Ulcers in Private Clinical Settings: A Survey of Australian Podiatrists 2021. [cited 2022 May 1]https:\/\/assets.researchsquare.com\/files\/rs\u20101157285\/v1_covered.pdf?c=1639584734","DOI":"10.21203\/rs.3.rs-1157285\/v1"},{"key":"e_1_2_14_17_1","unstructured":"Sveriges Kommuner och Regioner.V\u00e5rdf\u00f6rlopp Diabetes;2022.https:\/\/kunskapsstyrningvard.se\/kunskapsstyrningvard\/kunskapsstod\/publiceradekunskapsstod\/endokrinasjukdomar\/vardforloppdiabetes.64362.html"}],"container-title":["Diabetes\/Metabolism Research and Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dmrr.3611","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/dmrr.3611","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dmrr.3611","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T17:10:18Z","timestamp":1692637818000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dmrr.3611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,2]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1002\/dmrr.3611"],"URL":"https:\/\/doi.org\/10.1002\/dmrr.3611","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1002\/DMRR.3611\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/DMRR.3611\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/DMRR.3611\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/DMRR.3611\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/DMRR.3611\/v1\/review1","asserted-by":"object"}]},"ISSN":["1520-7552","1520-7560"],"issn-type":[{"value":"1520-7552","type":"print"},{"value":"1520-7560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,2]]},"assertion":[{"value":"2022-06-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e3611"}}