title: The management of diabetic foot ulcers through optimal off-loading: building consensus guidelines and practical recommendations to improve outcomes.
abstract: BACKGROUND
  We sought to develop a consensus statement for the use of off-loading in the management of diabetic foot ulcers (DFUs).
  
  
  METHODS
  A literature search of PubMed for evidence regarding off-loading of DFUs was initially conducted, followed by a meeting of authors on March 15, 2013, in Philadelphia, Pennsylvania, to draft consensus statements and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess quality of evidence and develop strength of recommendations for each consensus statement.
  
  
  RESULTS
  Evidence is clear that adequate off-loading increases the likelihood of DFU healing and that increased clinician use of effective off-loading is necessary. Recommendations are included to guide clinicians on the optimal use of off-loading based on an initial comprehensive patient/wound assessment and the necessity to improve patient adherence with off-loading devices.
  
  
  CONCLUSIONS
  The likelihood of DFU healing is increased with off-loading adherence, and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities. There currently exists a gap between what the evidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Snyder
authors.forename: Robert G
authors.initials: RG
authors.lastname: Frykberg
authors.forename: Lee C
authors.initials: LC
authors.lastname: Rogers
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Applewhite
authors.forename: Desmond
authors.initials: D
authors.lastname: Bell
authors.forename: Gregory
authors.initials: G
authors.lastname: Bohn
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Fife
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jensen
authors.forename: James
authors.initials: J
authors.lastname: Wilcox
mesh_terms: D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D009989:Orthotic Devices; D017410:Practice Guidelines as Topic