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Article

Offloading Strategies Used for Plantar Diabetic Foot Ulcers and Their Outcomes in Real-Life Clinical Practice

by
Afram Rumanes
1,2,*,
Jaap J. van Netten
3,4,5,
Kor H. Hutting
1,
Lisette J. E. W. C. van Gemert-Pijnen
2 and
Jeff G. van Baal
6,7
1
Department of Surgery, Hospital Group Twente, 7609 PP Almelo, The Netherlands
2
Department of Persuasive Health Technology, University of Twente, 7522 NB Enschede, The Netherlands
3
Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
4
Amsterdam Movement Sciences, Program Rehabilitation and Development, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
5
School of Public Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
6
ZGT Academy, Hospital Group Twente, 7600 SZ Almelo, The Netherlands
7
Scharenborg Groep, 10, 7555 SK Hengelo, The Netherlands
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(11), 3834; https://doi.org/10.3390/jcm14113834
Submission received: 24 April 2025 / Revised: 19 May 2025 / Accepted: 25 May 2025 / Published: 29 May 2025
(This article belongs to the Section Endocrinology & Metabolism)

Abstract

Introduction: International guidelines describe offloading to facilitate healing as a cornerstone in the treatment of diabetes-related foot ulcers. In present-day clinics, various offloading devices are used. The aim of this paper is to describe the effectiveness in healing of different offloading devices used in real-life clinical practice in patients with diabetes-related foot ulcers. Methods: A retrospective cohort study of 235 patients with a plantar foot ulcer in one diabetic foot centre of expertise was used. Clinical outcomes were determined during a follow-up period of 12 months. Groups were defined according to the types of offloading. Univariate and multivariate analysis was performed to assess ulcer-related outcomes in different offloading devices. Results: Of the 235 patients, 3% were treated with a Total Contact Cast (TCC), 9% with an ankle-high removable device, 32% with a custom-made orthopaedic shoe, 16% with a bandage shoe, and 39% with felted foam. Patients who received a bandage shoe or felted foam had a higher UT classification (Stage D in 21% and 18%, respectively, p = 0.001) and more ulcers per foot (13% and 5%, respectively, p = 0.002). The overall healing rate at 12 weeks was 33% and was not significantly different between the offloading device groups (p = 0.255). Healing rates at 20 and 52 weeks were 51.5% and 77%. Conclusions: Removable ankle-high offloading devices, orthopaedic shoes, bandage shoes, and felted foam are the most frequently used for plantar diabetic foot ulcers in clinical practice. This seems to be the result of various physician- and patient-related factors such as logistical reasons, patient factors, and severity of complicated ulcers. Diabetic foot ulcer healing after 12 weeks, 20 weeks, and 1-year follow-up were consistent with previous observational studies.
Keywords: diabetes mellitus; foot ulcers; offloading; ulcer healing diabetes mellitus; foot ulcers; offloading; ulcer healing

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MDPI and ACS Style

Rumanes, A.; van Netten, J.J.; Hutting, K.H.; van Gemert-Pijnen, L.J.E.W.C.; van Baal, J.G. Offloading Strategies Used for Plantar Diabetic Foot Ulcers and Their Outcomes in Real-Life Clinical Practice. J. Clin. Med. 2025, 14, 3834. https://doi.org/10.3390/jcm14113834

AMA Style

Rumanes A, van Netten JJ, Hutting KH, van Gemert-Pijnen LJEWC, van Baal JG. Offloading Strategies Used for Plantar Diabetic Foot Ulcers and Their Outcomes in Real-Life Clinical Practice. Journal of Clinical Medicine. 2025; 14(11):3834. https://doi.org/10.3390/jcm14113834

Chicago/Turabian Style

Rumanes, Afram, Jaap J. van Netten, Kor H. Hutting, Lisette J. E. W. C. van Gemert-Pijnen, and Jeff G. van Baal. 2025. "Offloading Strategies Used for Plantar Diabetic Foot Ulcers and Their Outcomes in Real-Life Clinical Practice" Journal of Clinical Medicine 14, no. 11: 3834. https://doi.org/10.3390/jcm14113834

APA Style

Rumanes, A., van Netten, J. J., Hutting, K. H., van Gemert-Pijnen, L. J. E. W. C., & van Baal, J. G. (2025). Offloading Strategies Used for Plantar Diabetic Foot Ulcers and Their Outcomes in Real-Life Clinical Practice. Journal of Clinical Medicine, 14(11), 3834. https://doi.org/10.3390/jcm14113834

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