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Yet the 2011 Australian DFU guidelines regarding offloading treatment are outdated. A national expert panel aimed to develop a new Australian guideline on offloading treatment for people with DFU by adapting international guidelines that have been assessed as suitable to adapt to the Australian context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>National Health and Medical Research Council procedures were used to adapt suitable International Working Group on the Diabetic Foot (IWGDF) guidelines to the Australian context. We systematically screened, assessed and judged all IWGDF offloading recommendations using best practice ADAPTE and GRADE frameworks to decide which recommendations should be adopted, adapted or excluded in the Australian context. For each recommendation, we re\u2010evaluated the wording, quality of evidence, strength of recommendation, and provided rationale, justifications and implementation considerations, including for geographically remote and Aboriginal and Torres Strait Islander peoples. This guideline, along with five accompanying Australian DFU guidelines, underwent public consultation, further revision and approval by ten national peak bodies (professional organisations).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 13 original IWGDF offloading treatment recommendations, we adopted four and adapted nine. The main reasons for adapting the IWGDF recommendations included differences in quality of evidence ratings and clarification of the intervention(s) and control treatment(s) in the recommendations for the Australian context. For Australians with plantar DFU, we recommend a step\u2010down offloading treatment approach based on their contraindications and tolerance. We strongly recommend non\u2010removable knee\u2010high offloading devices as first\u2010line treatment, removable knee\u2010high offloading devices as second\u2010line, removable ankle\u2010high offloading devices third\u2010line, and medical grade footwear as last\u2010line. We recommend considering using felted foam in combination with the chosen offloading device or footwear to further reduce plantar pressure. If offloading device options fail to heal a person with plantar DFU, we recommend considering various surgical offloading procedures. For people with non\u2010plantar DFU, depending on the type and location of the DFU, we recommend using a removable offloading device, felted foam, toe spacers or orthoses, or medical grade footwear. The six new guidelines and the full protocol can be found at: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/diabetesfeetaustralia.org\/new-guidelines\/\">https:\/\/diabetesfeetaustralia.org\/new\u2010guidelines\/<\/jats:ext-link>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have developed a new Australian evidence\u2010based guideline on offloading treatment for people with DFU that has been endorsed by ten key national peak bodies. Health professionals implementing these offloading recommendations in Australia should produce better DFU healing outcomes for their patients, communities, and country.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13047-022-00538-3","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T08:17:23Z","timestamp":1651738643000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Australian guideline on offloading treatment for foot ulcers: part of the 2021 Australian evidence\u2010based guidelines for diabetes\u2010related foot disease"],"prefix":"10.1002","volume":"15","author":[{"given":"Malindu E.","family":"Fernando","sequence":"first","affiliation":[{"name":"Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Australia"},{"name":"Faculty of Health and Medicine School of Health Sciences University of Newcastle 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Peoples Health Unit Faculty of Health Griffith University Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Cheney","sequence":"additional","affiliation":[{"name":"Diabetes Victoria Melbourne 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"}]},{"name":"Australian Diabetes\u2010related Foot Disease Guidelines & Pathways 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JChe is employed by Diabetes Victoria and is fully funded by the National Diabetes Services Scheme. PAL was an author of the IWGDF Offloading Guidelines and Systematic Review in which this manuscript is based, has been a speaker consultant with Sanofi Australia, is past\u00a0chair of Diabetes Feet Australia, and is a member of the Journal of Foot & Ankle Editorial Board, Diabetes Australia Research Advisory Panel, National Association of Diabetes Centres Foot Network Committee, Australian Foot Forward Project Committee and Aboriginal and Torres Strait Islander Diabetic Foot Complications Program Expert Advisory Committee. PAL was specifically involved with the development and drafting of non-surgical offloading recommendations in the IWGDF Offloading Guideline and addressed this conflict by not screening, assessing or deciding on any non-surgical offloading recommendations as part of this Australian Guideline project. All other authors declare that they have no relevant competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"31"}}