Jaap J van Netten1,2,3, Isabel C N Sacco4, Lawrence A Lavery5, Matilde Monteiro-Soares6, Anne Rasmussen7, Anita Raspovic8, Sicco A Bus1. 1. Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. 2. School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia. 3. Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands. 4. Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil. 5. Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. 6. MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto, Oporto, Portugal. 7. Steno Diabetes Center Copenhagen, Gentofte, Denmark. 8. Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
Abstract
BACKGROUND: Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. METHODS: The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self-management; pre-ulcer treatment; orthotic interventions; and foot- and mobility-related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre-ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. RESULTS: We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self-care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom-made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot- and mobility-related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. CONCLUSIONS: Structured education for patients and health care professionals, callus removal, custom-made therapeutic footwear, and foot- and mobility-related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.
BACKGROUND: Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. METHODS: The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self-management; pre-ulcer treatment; orthotic interventions; and foot- and mobility-related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre-ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. RESULTS: We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self-care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom-made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot- and mobility-related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. CONCLUSIONS: Structured education for patients and health care professionals, callus removal, custom-made therapeutic footwear, and foot- and mobility-related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.
Authors: Michelle R Kaminski; Jonathan Golledge; Joel W J Lasschuit; Karl-Heinz Schott; James Charles; Jane Cheney; Anita Raspovic Journal: J Foot Ankle Res Date: 2022-07-06 Impact factor: 3.050
Authors: Yuri F Hudak; Jing-Sheng Li; Scott Cullum; Brian M Strzelecki; Chris Richburg; G Eli Kaufman; Daniel Abrahamson; Jeffrey T Heckman; Beth Ripley; Scott Telfer; William R Ledoux; Brittney C Muir; Patrick M Aubin Journal: Med Eng Phys Date: 2022-04-14 Impact factor: 2.356
Authors: Jady Luara Veríssimo; Isabel C N Sacco; Maria Helena Morgani de Almeida; Cristina Dallemole Sartor; Eneida Yuri Suda Journal: Braz J Phys Ther Date: 2022-03-31 Impact factor: 4.762
Authors: Ronaldo H Cruvinel Júnior; Jane S S P Ferreira; Raquel I Beteli; Érica Q Silva; Jady L Veríssimo; Renan L Monteiro; Eneida Y Suda; Isabel C N Sacco Journal: Pilot Feasibility Stud Date: 2021-03-26
Authors: Tessa Riandini; Deanette Pang; Matthias P H S Toh; Chuen Seng Tan; Daveon Y K Liu; Andrew M T L Choong; Sadhana Chandrasekar; E Shyong Tai; Kelvin B Tan; Kavita Venkataraman Journal: Diabetologia Date: 2021-04-22 Impact factor: 10.122
Authors: Lorrany Junia Lopes de Lima; Matheus Rodrigues Lopes; Carlos Alberto de Lima Botelho; Roberta Stofeles Cecon Journal: J Vasc Bras Date: 2022-01-31
Authors: Maria Lazo-Porras; Antonio Bernabe-Ortiz; Alvaro Taype-Rondan; Robert H Gilman; German Malaga; Helard Manrique; Luis Neyra; Jorge Calderon; Miguel Pinto; David G Armstrong; Victor M Montori; J Jaime Miranda Journal: Wellcome Open Res Date: 2020-08-28