{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:51:58Z","timestamp":1792198318793,"version":"4.4.0"},"reference-count":62,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes\u2010related foot ulcers. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence\u2010based guideline on offloading interventions to promote healing of foot ulcers\u00a0in persons with diabetes. It serves as an update of the 2019 IWGDF guideline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We followed the GRADE approach by devising clinical\u00a0questions and important outcomes in the PICO (Patient\u2010Intervention\u2010Control\u2010Outcome) format, undertaking a systematic review and meta\u2010analyses, developing summary of judgement tables and writing recommendations and rationales for each question. Each recommendation is based on the evidence found in the systematic review, expert opinion where evidence was not available, and a careful weighing of GRADE summary of judgement items\u00a0including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, use a non\u2010removable knee\u2010high offloading device as the first\u2010choice offloading intervention. If contraindications or patient intolerance to non\u2010removable offloading exist, consider using a removable knee\u2010high or ankle\u2010high offloading device as the second\u2010choice offloading intervention. If no offloading devices are available, consider using appropriately fitting footwear combined with felted foam as the third\u2010choice offloading intervention. If such a non\u2010surgical offloading treatment fails to heal a plantar forefoot ulcer, consider an Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or metatarsal osteotomy. For healing a neuropathic plantar or apex lesser digit ulcer secondary to flexibile toe deformity, use digital flexor tendon tenotomy. For healing rearfoot, non\u2010plantar or ulcers complicated with infection or ischaemia, further recommendations have been outlined. All recommendations have been summarised in an offloading clinical pathway to help facilitate the implementation of this guideline into clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These offloading guideline recommendations should help healthcare professionals provide the best care and outcomes for persons with diabetes\u2010related foot ulcers and reduce the person's risk of infection, hospitalisation and amputation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3647","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T03:09:16Z","timestamp":1684984156000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":150,"title":["Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update)"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco A.","family":"Bus","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC Location University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Movement Science Program Rehabilitation &amp; Development  Amsterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Surgery Southwestern Academic Limb Salvage Alliance (SALSA) Keck School of Medicine of University of Southern California (USC)  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan T.","family":"Crews","sequence":"additional","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5026-6788","authenticated-orcid":false,"given":"Catherine","family":"Gooday","sequence":"additional","affiliation":[{"name":"Elsie Bertram Diabetes Centre Norfolk and Norwich University Hospitals  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6410-2474","authenticated-orcid":false,"given":"Gustav","family":"Jarl","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Department of Prosthetics and Orthotics \u00d6rebro University  \u00d6rebro Sweden"},{"name":"Faculty of Medicine and Health University Health Care Research Center \u00d6rebro University  \u00d6rebro 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