{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:51:07Z","timestamp":1781931067127,"version":"3.54.5"},"reference-count":18,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01DK131303"],"award-info":[{"award-number":["R01DK131303"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"abstract":"<jats:p>Introduction: Offloading adherence (OA) is critical for diabetic foot ulcer (DFU) healing. This report investigated whether DFU patients with low overall OA (&lt;20%) limit offloading device usage to days they come to the clinic. Methods: Activity monitors measured OA 24 h\/day. Daily walking and standing OA were calculated for up to four weeks, and participants self-reported their cumulative adherence. Each day was classified as to whether a DFU-related clinic visit occurred. Results: Four participants from an ongoing RCT were identified with &lt;20% overall adherence, despite self-reporting 65\u201380% adherence. Most days they did not wear their devices at all, while the majority of wear-days coincided with footcare visits. Conclusions: This report describes a cohort that had low daily OA yet consistently wore their devices to the clinic and self-reported inflated OA. To improve OA and DFU healing, more research is needed to understand this phenomenon and help clinicians ascertain adherence during patient encounters.<\/jats:p>","DOI":"10.3390\/japma116030041","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:33:54Z","timestamp":1781768034000},"page":"41","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Offloading Adherence for Appearance\u2019s Sake?"],"prefix":"10.3390","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-1960","authenticated-orcid":false,"given":"Ryan T.","family":"Crews","sequence":"first","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5266-0707","authenticated-orcid":false,"given":"Nahir","family":"Negron-Fernandez","sequence":"additional","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-4494","authenticated-orcid":false,"given":"Sai V.","family":"Yalla","sequence":"additional","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3680-3182","authenticated-orcid":false,"given":"Adam E.","family":"Fleischer","sequence":"additional","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-1201","authenticated-orcid":false,"given":"Andrew J. M.","family":"Boulton","sequence":"additional","affiliation":[{"name":"Department of Medicine, Manchester Royal Infirmary, Manchester M13 9WL, UK"},{"name":"Diabetes Research Institute, University of Miami, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-4580","authenticated-orcid":false,"given":"Neil D.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8514-2128","authenticated-orcid":false,"given":"Loretta","family":"Vileikyte","sequence":"additional","affiliation":[{"name":"Diabetes Research Institute, University of Miami, Miami, FL 33136, USA"},{"name":"Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3901-7961","authenticated-orcid":false,"given":"Noah J.","family":"Rosenblatt","sequence":"additional","affiliation":[{"name":"Dr. William M. Scholl College of Podiatric Medicine\u2019s Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e3747","DOI":"10.1002\/dmrr.3747","article-title":"A new declaration for feet\u2019s sake: Halving the global diabetic foot disease burden from 2% to 1% with next generation care","volume":"40","author":"Lazzarini","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e3650","DOI":"10.1002\/dmrr.3650","article-title":"Effectiveness of offloading interventions for people with diabetes-related foot ulcers: A systematic review and meta-analysis","volume":"40","author":"Lazzarini","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e3647","DOI":"10.1002\/dmrr.3647","article-title":"Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update)","volume":"40","author":"Bus","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"555","DOI":"10.7547\/8750-7315-104.6.555","article-title":"The management of diabetic foot ulcers through optimal off-loading: Building consensus guidelines and practical recommendations to improve outcomes","volume":"104","author":"Snyder","year":"2014","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.2337\/dc15-2373","article-title":"Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation","volume":"39","author":"Crews","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.2337\/diacare.26.9.2595","article-title":"Activity Patterns of Patients With Diabetic Foot Ulceration: Patients with active ulceration may not adhere to a standard pressure off-loading regimen","volume":"26","author":"Armstrong","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e002640","DOI":"10.1136\/bmjdrc-2021-002640","article-title":"Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers","volume":"10","author":"Ababneh","year":"2022","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"20420188221142457","DOI":"10.1177\/20420188221142457","article-title":"Differences in adherence to using removable cast walker treatment during daytime and nighttime weight-bearing activities in people with diabetes-related foot ulcers","volume":"14","author":"Ababneh","year":"2023","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4423","DOI":"10.3390\/s23094423","article-title":"The Validity and Reliability of Self-Reported Adherence to Using Offloading Treatment in People with Diabetes-Related Foot Ulcers","volume":"23","author":"Ababneh","year":"2023","journal-title":"Sensors"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100","DOI":"10.7547\/0980100","article-title":"A method for assessing off-loading compliance","volume":"99","author":"Crews","year":"2009","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13063-020-05017-3","article-title":"Diabetes management intervention studies: Lessons learned from two studies","volume":"22","author":"Petersen","year":"2021","journal-title":"Trials"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2281316","DOI":"10.1080\/08037051.2023.2281316","article-title":"Lessons learned from conducting a randomized controlled trial to improve non-adherence to antihypertensive drug treatment","volume":"32","author":"Peeters","year":"2023","journal-title":"Blood Press."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.2337\/dc13-2470","article-title":"Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients","volume":"37","author":"Waaijman","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.2337\/dc12-1330","article-title":"Adherence to wearing prescription custom-made footwear in patients with diabetes at high risk for plantar foot ulceration","volume":"36","author":"Waaijman","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/(SICI)1096-9136(199612)13:12<1064::AID-DIA253>3.0.CO;2-#","article-title":"Do people with diabetes wear their prescribed footwear?","volume":"13","author":"Knowles","year":"1996","journal-title":"Diabet. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Meisters, J., Hoffmann, A., and Musch, J. (2020). Controlling social desirability bias: An experimental investigation of the extended crosswise model. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243384"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1177\/1932296816651631","article-title":"Monitoring Location-Specific Physical Activity via Integration of Accelerometry and Geotechnology Within Patients with or at Risk of Diabetic Foot Ulcers: A Technological Report","volume":"11","author":"Crews","year":"2017","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13047-020-00413-z","article-title":"Predictors of adherence to wearing therapeutic footwear among people with diabetes","volume":"13","author":"Jarl","year":"2020","journal-title":"J. Foot Ankle Res."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/41\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:15:11Z","timestamp":1781928911000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/41"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["japma116030041"],"URL":"https:\/\/doi.org\/10.3390\/japma116030041","relation":{},"ISSN":["1930-8264"],"issn-type":[{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]}}}