title: Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?
abstract: OBJECTIVE
  Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices.
  
  
  METHODS
  A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of diabetic foot ulcers in each center.
  
  
  RESULTS
  Of the 895 respondents who treat diabetic foot ulcers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation, whereas total contact casts were used by only 1.7% of the centers.
  
  
  CONCLUSIONS
  This study reports the usage and characteristics of offloading devices in the care of diabetic foot ulcers in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the "gold standard" (total contact cast) for treating the majority of diabetic foot ulcers.
authors.affiliation: Scholl's Center for Lower-Extremity Ambulatory Research, Rosalind Franklin Universityof Medicine and Science, North Chicago, Illinois, USA. stephanie.wu@rosalindfranklin.edu
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Wu
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jensen
authors.forename: Anna K
authors.initials: AK
authors.lastname: Weber
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Robinson
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
mesh_terms: D017719:Diabetic Foot / Q000453:epidemiology / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D011312:Pressure; D012775:Shoes; D014481:United States / Q000453:epidemiology