Berhane, Thomas

Jeyaraman, Kanakamani

Hamilton, Mark

Falhammar, Henrik

2022-01-18

BACKGROUND: Offloading intervention is an important component in the management of diabetes-related foot ulcer (DFU). The NT population is unique with certain distinctive challenges. Potential advantages of and barriers to optimal offloading methods in our setting were investigated. METHODS: Consecutive patients with DFU treated with offloading devices between 2003 and 2015 at the Multidisciplinary Foot Clinic (MDFC), Royal Darwin Hospital were included. The outcome measures were healing, amputation and discontinuation. Risk factors for offloading failure were studied. RESULTS: Total contact cast (TCC) was the most common offloading used (n = 175). The other removable non-TCC devices used were therapeutic footwear (n = 74), CamWalker (n = 35), and orthotic devices (n = 43). The overall healing rate was 88.7%. Healing rates were higher (93.2% versus 83.5%, P < 0.05) and amputation rates were lower (4.0% versus 7.3%, P = 0.026) in the TCC group than in the removable non-TCC group. The mean duration of offloading was longer in the TCC group (3.6 ± 1.5 versus. 3.2 ± 1.5 months, P = 0.008). Wagner grade ≥ 2 and removable non-TCC devices were significant risk factors for offloading failure. CONCLUSION: Patients treated with TCC had higher healing rates than those treated with removable non-TCC devices. The duration of offloading was longer than reported in other studies. Higher Wagner grade and removable non-TCC devices were risk factors for offloading failure. Non-removable offloading devices are the first choice in diabetes-related neuropathic ulcers.

Department of Prosthetics and Orthotics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Vascular Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.

Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.

ANZ J Surg . 2022 Apr;92(4):723-729. doi: 10.1111/ans.17431. Epub 2022 Jan 18.

0000-0002-8220-1302

https://pubmed.ncbi.nlm.nih.gov/35040542/?otool=iaurydwlib

https://hdl.handle.net/10137/12098

Pressure relieving interventions for the management of diabetes-related foot ulcers: a study from the Northern Territory of Australia.

Journal Article

Publication