Here's an intriguing meta-analysis from a team in Adelaide in South Australia. In a recently published study in Diabetes/Metabolism Research and Reviews, Morona and colleagues compared different offloading devices for neuropathic foot ulcers in patients with diabetes.1
The researchers searched medical bibliographic databases, the Internet and reference lists from January 1966 to May 2012. They focused on systematic reviews and controlled studies comparing the use of different offloading devices.
The authors found that in comparison to removable devices, non-removable offloading devices were, on average, more effective at promoting the healing of diabetic foot ulcers. The study authors theorize that this is because non-removable offloading devices facilitate patient adherence. While they did not note a statistically significant difference between non-removable devices and removable cast walkers, the study authors did note that non-removable offloading devices performed better than therapeutic shoes. The researchers found that total contact casts and instant total contact casts were equally effective.
While we at the Southern Arizona Limb Salvage Alliance start off with irremovable offloading devices for most of our patients with non-healing, highly ischemic wounds, I think that one can consider starting someone on a removable device and move toward irremovable if the wound does not progress over the first few weeks.
1. Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL. Comparison of the clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2013 Jan 10. Epub ahead of print.
This blog has been adapted with permission from a blog that previously appeared at http://www.diabeticfootonline.blogspot.com/2013/01/offloading-wounds-har...  .