{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T11:35:19Z","timestamp":1793878519362,"version":"4.7.0"},"reference-count":77,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T00:00:00Z","timestamp":1654300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Diabetes Sci Technol"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each individual\u2019s needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls\/struts, etc.) can be added or removed from the device to accommodate different patients\u2019 needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19322968221101632","type":"journal-article","created":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T03:21:38Z","timestamp":1654312898000},"page":"99-106","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6410-2474","authenticated-orcid":false,"given":"Gustav","family":"Jarl","sequence":"first","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"}]},{"given":"David F.","family":"Rusaw","sequence":"additional","affiliation":[{"name":"School of Health and Welfare, J\u00f6nk\u00f6ping University, J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2784-621X","authenticated-orcid":false,"given":"Alexander J.","family":"Terrill","sequence":"additional","affiliation":[{"name":"School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia"},{"name":"Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia"},{"name":"Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleveland T.","family":"Barnett","sequence":"additional","affiliation":[{"name":"School of Science and Technology, Nottingham Trent University, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A.","family":"Woodruff","sequence":"additional","affiliation":[{"name":"School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia"},{"name":"Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-7964","authenticated-orcid":false,"given":"Peter A.","family":"Lazzarini","sequence":"additional","affiliation":[{"name":"School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia"},{"name":"Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,6,4]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1614."},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","first-page":"e3274","DOI":"10.1002\/dmrr.3274","article-title":"Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Bus SA","year":"2020","unstructured":"Bus SA, Armstrong DG, Gooday C, et al. 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