New guidelines recommend off-loading to increase likelihood of diabetic foot ulcer healing

Relieving pressure on the foot through the use of off-loading improves healing outcomes and reduces complications in patients with diabetic foot ulcers, according to consensus guidelines published in the Journal of the American Podiatric Medical Association.

 “The Management of Diabetic Foot Ulcers Through Optimal Off-Loading – Building Consensus Guidelines and Practical Recommendations to Improve Outcomes” was authored by a multidisciplinary panel of nine experts who were supported by Derma Sciences Inc. The document was developed to provide evidence-based consensus on the optimal use of off-loading as treatment for diabetic foot ulcers (DFUs), a debilitating and costly condition that can lead to amputation of the foot and other lower extremities.

Among patients with diabetes, 15% are at risk for developing a DFU and 85% of lower extremity amputations in diabetic patients are preceded by a foot ulcer. The projected lifetime health care cost for patients with DFUs who undergo amputation is approximately $509,000.

“Publishing this paper is intended to bridge the gap between evidence supporting the effectiveness of off-loading for diabetic foot ulcers and its use in clinical practice, and to guide the wound care decision-making process,” Robert J. Snyder, DPM, MSc, professor and director of Clinical Research at Barry University School of Podiatric Medicine and lead author of the consensus guidelines, stated in a press release. “It is our hope that this manuscript will foster meaningful off-loading of DFUs by the specialist and generalist alike.”

A literature review of approximately 90 studies conducted by the expert panel resulted in the following eight evidence-based consensus guidelines and core recommendations:

  • The VIPs (vascular management, infection management and prevention, and pressure relief) are essential to DFU healing.
  • Adequate off-loading increases the likelihood of DFU healing.
  • For guidance on off-loading the Charcot foot, the panel endorses the Charcot foot in diabetes consensus report published in 2011.
  • Total contact cast (TCC) is the preferred method for off-loading plantar DFUs, as it has most consistently demonstrated the best healing outcomes and is a cost-effective treatment.
  • There currently exists a “gap” between the evidence supporting the efficacy of DFU off-loading and what is performed in clinical practice.
  • The likelihood of DFU healing is increased with off-loading adherence.
  • Advanced therapeutics are unlikely to succeed in improving wound-healing outcomes unless effective off-loading is obtained.
  • The panel supports the development of a per-visit off-loading quality measure to address the gap between evidence of off-loading and its current use in clinical practice.

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