Document Detail

Pressure-relieving interventions for treating diabetic foot ulcers.
MedLine Citation:
PMID:  23440787     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Diabetes-related foot ulceration is a major contributor to morbidity in diabetes. Diabetic foot ulcers are partly a consequence of abnormal foot pressures and pressure relief is a widely used treatment for healing diabetes-related plantar foot ulcers, but the most effective method for healing is unclear.
OBJECTIVES: To determine the effects of pressure-relieving interventions on the healing of foot ulcers in people with diabetes.
SEARCH METHODS: For this update we searched the Cochrane Wounds Group Specialised Register (searched 2 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (1950 to October Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, October 31, 2012); Ovid EMBASE (1980 to 2012 Week 43); and EBSCO CINAHL (1982 to 1 November 2012). There were no restrictions based on language or publication status.
SELECTION CRITERIA: Randomised controlled trials evaluating the effects of pressure-relieving interventions on the healing of foot ulcers in people with diabetes.
DATA COLLECTION AND ANALYSIS: Data from eligible trials were extracted, and summarised using a data extraction sheet, by two review authors independently.
MAIN RESULTS: Fourteen trials (709 participants) met the inclusion criteria for the review. One study compared two different types of non-removable casts with no discernable difference between the groups. Seven studies (366 participants) compared non-removable casts with removable pressure-relieving devices. In five of those studies non-removable casts were associated with a statistically significant increase in the number of ulcers healed compared with the removable device (RR 1.17 95% CI 1.01 to 1.36: P value = 0.04).Two studies (98 participants) found that significantly more ulcers healed with non-removable casts than with dressings alone. Achilles tendon lengthening combined with a non-removable cast in one study resulted in significantly more healed ulcers at 7 months than non-removable cast alone (RR 2.23; 95% CI 1.32 to 3.76). More ulcers remained healed at two years in this group (RR 3.41; 95% CI 1.42 to 8.18).Other comparisons included surgical debridement of ulcers; felt fitted to the foot; felted foam dressings and none of these showed a statistically significant treatment effect in favour of the intervention.
AUTHORS' CONCLUSIONS: Non-removable, pressure-relieving casts are more effective in healing diabetes related plantar foot ulcers than removable casts, or dressings alone. Non-removable devices, when combined with Achilles tendon lengthening were more successful in one forefoot ulcer study than the use of a non-removable cast alone.
Jane Lewis; Allyson Lipp
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-31
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  1     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2013  
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-03-12     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD002302     Citation Subset:  IM    
Cardiff and Vale University Health Board, Cardiff, UK.
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MeSH Terms
Achilles Tendon / surgery
Casts, Surgical
Debridement / methods
Diabetic Foot / therapy*
Foot Orthoses
Pressure Ulcer / therapy*
Randomized Controlled Trials as Topic
Tenotomy / methods
Time Factors
Wound Healing
Grant Support
//Department of Health
Update Of:
Cochrane Database Syst Rev. 2000;(3):CD002302   [PMID:  10908550 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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