The Effectiveness of Footwear and Other Removable Off-loading Devices in the Treatment of Diabetic Foot Ulcers: A Systematic Review

Aim: To conduct a systematic review which examined the effectiveness of footwear and other removable off-loading devices as interventions for the treatment of diabetic foot ulcers or the alteration of biomechanical factors associated with ulcer healing and to discuss the quality and interpret the findings of research to date. Methods: The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with seventeen articles identified for review. Results: Majority of the identified studies were randomised control trials which compared the ulcer healing rates of different footwear and other removable off-loading device interventions. Three categories of interventions were identified; 1) removable cast walkers (RCWs), 2) half or heel relief shoes and 3) therapeutic shoes. Most studies compared at least one intervention to a total contact cast (TCC). Factors which influenced study findings such as TCC application method, compliance, activity levels, and the footwear worn on the contralateral limb are discussed with recommendations provided for future studies. Conclusion: Due to the lack of randomised controlled studies conducted in this area it is not currently possible to make strong conclusions on the interventions effectiveness. However, it appears the currently available therapeutic shoes were the least effective intervention followed by half or heel relief shoes. RCWs were found to be the most effective of the removable devices. Keywords: Biomechanics, diabetes, footwear, plantar pressure, pressure reduction, ulceration.