{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:48:54Z","timestamp":1782200934409,"version":"3.54.5"},"reference-count":49,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    To evaluate the effectiveness of multidisciplinary offloading versus standard care on one\u2010year diabetic foot ulcer recurrence, amputation, mortality, and functional recovery. In this prospective cohort study, 232 patients with healed diabetic foot ulcers were stratified into a control group (76 patients) or an intervention group (156 patients) receiving offloading modalities ranging from felt padding to custom\u2010made therapeutic footwear. Assignment was based on shared decision\u2010making considering biomechanical needs and economic feasibility. Primary outcomes included recurrence, amputation, and mortality. Secondary outcomes assessed quality of life, working ability, and ankle function. The intervention group demonstrated significantly lower recurrence (10.9% vs. 25.0%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007) and mortality (3.2% vs. 14.5%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004). Multivariable analysis identified offloading as independently protective against recurrence (odds ratio 0.35) and mortality (odds ratio 0.24). Amputation rates did not differ significantly after adjustment. Functionally, the intervention group achieved superior recovery in quality of life, working ability, and ankle scores (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Subgroup analysis indicated that customized therapeutic footwear yielded the lowest complication rates and highest patient satisfaction. Multidisciplinary offloading significantly reduces recurrence and mortality while restoring physical function. Although financial barriers influence device selection, customized therapeutic footwear offers the optimal balance of biomechanical protection and functional outcomes.\n                  <\/jats:p>","DOI":"10.1111\/iwj.70975","type":"journal-article","created":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T23:31:22Z","timestamp":1781479882000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidisciplinary Offloading for Healed Diabetic Foot Ulcers: A Prospective Study on Functional Outcomes and Predictors of Recurrence, Amputation, and Mortality"],"prefix":"10.1111","volume":"23","author":[{"given":"Chia\u2010Yu","family":"Wang","sequence":"first","affiliation":[{"name":"School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"},{"name":"Department of Medical Education Taipei Medical University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Yuu","family":"Koo","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"},{"name":"Division of Colorectal Surgery, Department of Surgery Far Eastern Memorial Hospital  New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung\u2010Hsuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Integrated Burn &amp; Wound Care Center, Department of Surgery Shuang\u2010Ho Hospital  New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka\u2010Wai","family":"Tam","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, School of Medicine Shuang\u2010Ho Hospital, Taipei Medical University  New Taipei City Taiwan"},{"name":"Cochrane Taiwan, Taipei Medical University  Taipei Taiwan"},{"name":"Department of Surgery, School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8268-9176","authenticated-orcid":false,"given":"Yi\u2010Chun","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Integrated Burn &amp; Wound Care Center, Department of Surgery Shuang\u2010Ho Hospital  New Taipei City Taiwan"},{"name":"Department of Surgery, School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"},{"name":"Department of Biomedical Engineering National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun\u2010Cheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Integrated Burn &amp; Wound Care Center, Department of Surgery Shuang\u2010Ho Hospital  New Taipei City Taiwan"},{"name":"Department of Surgery, School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-9021"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3651"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v11.i8.1684"},{"key":"e_1_2_13_6_1","volume-title":"IDF Diabetes Atlas","author":"Federation ID","year":"2025"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-022-05845-9"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/7991031"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0043"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7631659"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2018.0814"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3686"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta19570"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-3120"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2022.109239"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3657"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3786"},{"key":"e_1_2_13_18_1","volume-title":"Diabetic Foot Problems: Prevention and Management","author":"National Institute for Health and Care Excellence: Guidelines","year":"2023"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000248116.28131.94"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.10578"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001192"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.10.003"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(00)90054-9"},{"key":"e_1_2_13_24_1","volume-title":"Programme on Mental Health: WHOQOL User Manual","author":"Organization WH","year":"2012"},{"key":"e_1_2_13_25_1","volume-title":"Taiwan Physical Fitness Guidelines","author":"Health Promotion Administration MoHaW","year":"2010"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-020-00383-2"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.70173"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering12111217"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13531"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.17925\/EE.2023.19.1.85"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s44337-025-00285-x"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38875.675486.55"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2022.05.001"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-024-06316-z"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14840"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9093009"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(24)00110-4"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14144975"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.09.025"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.9.1428"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/9742665"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1622055"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-S012"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-0996"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05098-8"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0304443"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2010.04.001"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-1836"},{"key":"e_1_2_13_49_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9103291"},{"key":"e_1_2_13_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3647"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70975","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.70975","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70975","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:21:42Z","timestamp":1782199302000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.70975"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":49,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/iwj.70975"],"URL":"https:\/\/doi.org\/10.1111\/iwj.70975","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-01-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70975"}}