Introduction and Objective: Offloading is a cornerstone of diabetic foot ulcer management, yet uncertainty remains regarding the comparative effectiveness of available offloading modalities. The objective of this study was to compare clinical outcomes associated with offloading strategies for diabetic foot ulcers.Methods: We performed a meta-analysis of studies evaluating offloading modalities for diabetic foot ulcers. Included studies compared total contact casts (TCC), instant total contact casts (iTCC), removable walker boots (RWB) and therapeutic footwear. Outcomes included healing and time to heal, with pooled odds ratios or mean differences and 95% confidence intervals calculated using random-effects models in RevMan 5.4.Results: TCC demonstrated higher healing rates vs. RWB and no difference in time to heal. TCC had a higher rate of healing and faster healing times compared to shoes. RWB had faster times to heal compared to shoes with no differences in incidence of healed DFUs (Tables 1). There were no differences in TCC vs. iTCC outcomes. iTCC had shorter healing times compared to RWB with no differences in healing rate.Conclusion: Non removable offloading strategies, particularly TCCs, were associated with improved healing outcomes compared to removable devices and footwear, supporting their use in diabetic foot ulcer management.
A. Tarricone: None. N. Thirugnanasambandam: None. L. Lavery: Consultant; Current; ConvaTec Inc., Tissue Health Plus, Clyra medical. Speaker’s Bureau; Current; inari medical.
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