Pressure relieving interventions for preventing and treating diabetic foot ulcers

Spencer SA

Published Online:

July 16, 2008

Foot ulcers (open sores) are common in people with diabetes, especially those with problems in the nerves (peripheral neuropathy) or arteries of their legs (peripheral vascular disease). Weight and mobility problems can lead to ulcers. Complications can lead to amputation (surgical removal of part of the limb). The review of trials found that orthotics (in-shoe devices) that cushion or redistribute pressure may be able to prevent foot ulcers in people with diabetes, but there is no strong evidence about running shoes or foam inlays. More research is needed on what can help prevent or relieve foot ulcers in diabetes.

Abstract (click to read)

Background:

Foot ulceration is thought to affect 15% of all people with diabetes at some time during their life.

Objectives:

To assess the effectiveness of pressure relieving interventions in the prevention and treatment of diabetic foot ulcers.

Search strategy:

Searches of 19 databases, hand searching of journals, bibliographies and identification of unpublished work by written communication with recognised experts in the diabetic foot.

Selection criteria:

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 collection and analysis:

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.

Main results:

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.

Authors' conclusions:

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.

This record should be cited as:

Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302

Assessed as up to date:

May 8, 2000

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Primary Review Group:

Wounds Group

Health topics:

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Pressure relieving interventions for preventing and treating diabetic foot ulcers

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