{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:44:08Z","timestamp":1789656248134,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,10,23]],"date-time":"2017-10-23T00:00:00Z","timestamp":1508716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"INTERREG IIIA, Euregio, of the European Union","award":["2-EUR-II-2=60"],"award-info":[{"award-number":["2-EUR-II-2=60"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Non\u2010removable offloading is the \u2018gold standard\u2019 treatment for neuropathic diabetic plantar forefoot ulcers. However, removable offloading is the common \u2018standard of care\u2019. We compared three removable offloading devices for ulcer healing efficacy. In this multicentre, randomised controlled trial, 60 persons with neuropathic diabetic plantar forefoot ulcers were randomly assigned to wear a custom\u2010made knee\u2010high cast [BTCC (bivalved TCC)], custom\u2010made ankle\u2010high cast shoe or a prefabricated ankle\u2010high forefoot\u2010offloading shoe (FOS). Primary outcome was healing at 12 weeks. Dynamic plantar pressures, daily stride count and treatment adherence were assessed on a randomly selected subset (\n                    <jats:italic>n<\/jats:italic>\n                    = 35). According to intention\u2010to\u2010treat analysis, 58% of patients healed with BTCC [OR 0\u00b777 (95% CI 0\u00b741\u20131\u00b745) versus FOS], 60% with cast shoe [OR 0\u00b781 (95% CI 0\u00b744\u20131\u00b749) versus FOS] and 70% with FOS (\n                    <jats:italic>P<\/jats:italic>\n                    = 0\u00b770). Mean \u00b1 SD peak pressure in kPa at the ulcer site was 81 \u00b1 55 for BTCC, 176 \u00b1 80 for cast shoe and 107 \u00b1 52 for FOS (\n                    <jats:italic>P<\/jats:italic>\n                    = 0\u00b7005); stride count was 4150 \u00b1 1626, 3514 \u00b1 1380 and 4447 \u00b1 3190, respectively (\n                    <jats:italic>P<\/jats:italic>\n                    = 0\u00b771); percentage of 2\u2010week intervals that patients wore the device &lt;50% of time was 17\u00b73%, 5\u00b72% and 4\u00b79%, respectively. Non\u2010significant differences in healing efficacy between the three devices suggest that, when non\u2010removable offloading is contraindicated or not available, each can be used for plantar forefoot ulcer offloading. Efficacy is lower than previously found for non\u2010removable offloading maybe because suboptimal adherence and high stride count expose the patient to high repetitive stresses. These factors should be carefully considered in decision making regarding ulcer treatment.\n                  <\/jats:p>","DOI":"10.1111\/iwj.12835","type":"journal-article","created":{"date-parts":[[2017,10,23]],"date-time":"2017-10-23T02:02:41Z","timestamp":1508724161000},"page":"65-74","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single\u2010blinded multicentre randomised controlled trial"],"prefix":"10.1111","volume":"15","author":[{"given":"Sicco A","family":"Bus","sequence":"first","affiliation":[{"name":"Department of Surgery Ziekenhuisgroep Twente, Almelo and Hengelo  the Netherlands"},{"name":"Department of Rehabilitation Medicine Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaap J","family":"van Netten","sequence":"additional","affiliation":[{"name":"Department of Surgery Ziekenhuisgroep Twente, Almelo and Hengelo  the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke IR","family":"Kottink","sequence":"additional","affiliation":[{"name":"Department of Surgery Ziekenhuisgroep Twente, Almelo and Hengelo  the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik A","family":"Manning","sequence":"additional","affiliation":[{"name":"Department of Surgery Ziekenhuisgroep Twente, Almelo and Hengelo  the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Spraul","sequence":"additional","affiliation":[{"name":"Department of Diabetology Mathias Spital  Rheine Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend\u2010Jan","family":"Woittiez","sequence":"additional","affiliation":[{"name":"Department of Nephrology Ziekenhuisgroep Twente, Almelo and Hengelo  the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff G","family":"van Baal","sequence":"additional","affiliation":[{"name":"Department of Surgery Ziekenhuisgroep Twente, Almelo and Hengelo  the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67698-2"},{"issue":"5","key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/dmrr.706","article-title":"Economic aspects of diabetic foot care in a multidisciplinary setting: a 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