Pressure relieving interventions for preventing and treating diabetic foot ulcers

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Abstract
Foot ulceration is thought to affect 15% of all people with diabetes at some time during their life. To assess the effectiveness of pressure relieving interventions in the prevention and treatment of diabetic foot ulcers. Searches of 19 databases, hand searching of journals, bibliographies and identification of unpublished work by written communication with recognised experts in the diabetic foot. Randomised controlled trials evaluating pressure relieving interventions either in the prevention or the treatment of diabetic foot ulcers. There was no restriction on articles/trials based on language or publication status. Data extraction and assessment of study quality was undertaken by two reviewers independently. Each trial was analysed separately, no pooling of results was possible due to the difference in patients, comparisons and outcomes. Prevention 4 RCTs of pressure relieving interventions were identified. Interventions for the prevention of diabetic foot ulcers indicated that in-shoe orthotics are of benefit. The relative merits of different in-shoe orthotics are unclear; cushioning and pressure redistribution appear of equal benefit. Other pressure relieving interventions such as running shoes have not been adequately evaluated and removable casts (Scotchcast or Hope) or foam inlays do not appear to have been evaluated at all in randomised controlled studies. Treatment 1 RCT of total contact casting indicated that it was effective in the treatment of diabetic ulcers although the evidence was limited. Prevention There is limited evidence of the effectiveness of orthotic interventions over removal of callus. There is some evidence evaluating the relative effectiveness of two types orthotic devices. There is very limited evidence of the effectiveness of therapeutic shoes. Treatment There is very limited evidence of the effectiveness of total contact casts in the treatment of diabetic foot ulcers. Overall there is a need to measure the effectiveness of the range of pressure relieving interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount of poor quality research in this area.