Pressure relieving interventions for

preventing and treating diabetic foot ulcers

1. Sue A Spencer*

Editorial Group: Cochrane Wounds Group

Published Online: 24 JUL 2000

Assessed as up-to-date: 7 MAY 2000

DOI: 10.1002/14651858.CD002302

Abstract
Background

Foot ulceration is thought to affect 15% of all people with diabetes at some time during their life.

Objectives

To assess the effectiveness of pressure relieving interventions in the prevention and treatment of
diabetic foot ulcers.

Search methods

Searches of 19 databases, hand searching of journals, bibliographies and identification of

unpublished work by written communication with recognised experts in the diabetic foot.

Selection criteria

Randomised controlled trials evaluating pressure relieving interventions either in the prevention
or the treatment of diabetic foot ulcers. There was no restriction on articles/trials based on
language or publication status.

Data collection and analysis

Data extraction and assessment of study quality was undertaken by two reviewers independently.
Each trial was analysed separately, no pooling of results was possible due to the difference in
patients, comparisons and outcomes.
Main results

Prevention
4 RCTs of pressure relieving interventions were identified.
Interventions for the prevention of diabetic foot ulcers indicated that in-shoe orthotics are of
benefit. The relative merits of different in-shoe orthotics are unclear; cushioning and pressure
redistribution appear of equal benefit. Other pressure relieving interventions such as running
shoes have not been adequately evaluated and removable casts (Scotchcast or Hope) or foam
inlays do not appear to have been evaluated at all in randomised controlled studies.
Treatment
1 RCT of total contact casting indicated that it was effective in the treatment of diabetic ulcers
although the evidence was limited.

Authors' conclusions

Prevention
There is limited evidence of the effectiveness of orthotic interventions over removal of callus.
There is some evidence evaluating the relative effectiveness of two types orthotic devices.
There is very limited evidence of the effectiveness of therapeutic shoes.
Treatment
There is very limited evidence of the effectiveness of total contact casts in the treatment of
diabetic foot ulcers.

Overall there is a need to measure the effectiveness of the range of pressure relieving
interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount
of poor quality research in this area.

Plain language summary

Pressure relieving interventions for preventing and treating diabetic foot
ulcers

Foot ulcers (open sores) are common in people with diabetes, especially those with problems in
the nerves (peripheral neuropathy) or arteries of their legs (peripheral vascular disease). Weight
and mobility problems can lead to ulcers. Complications can lead to amputation (surgical
removal of part of the limb). The review of trials found that orthotics (in-shoe devices) that
cushion or redistribute pressure may be able to prevent foot ulcers in people with diabetes, but
there is no strong evidence about running shoes or foam inlays. More research is needed on what
can help prevent or relieve foot ulcers in diabetes.
摘要