title: Treatment of the diabetic foot by offloading: a systematic review.
abstract: OBJECTIVE
  To compare the literature on the strengths and limitations of different offloading devices in the treatment of diabetic foot ulcers.
  
  
  METHODS
  Systematic review of the literature in the following databases: the Cumulative Index to Nursing an Allied Health Literature (CINAHL); Medline; Embase; Cochrane Library and Web of Knowledge. The search strategy used the terms: diabetic foot; orthosis/orthotic devices/orthoses; foot orthosis/foot orthoses; casts/plaster cast/surgical cast; shoes.
  
  
  RESULTS
  Our results identified 15 studies, which are included in this review. Healing rates, healing times and reduction in ulcer size were improved with the use of total contact casting, when compared with other offloading devices. The main adverse effects associated with the use of the device were infection, maceration and abrasion. Cost, compliance and quality of life issues were rarely included within the studies.
  
  
  CONCLUSIONS
  Offloading is a key treatment strategy for the management of diabetic foot ulcers and total contact casts were found to be the most effective devices to achieve ulcer healing. However, they are not without complications and their impact on cost, compliance and quality of life is not well understood.
authors.affiliation: Staff Nurse, Professor and Head of the School of Nursing and Midwifery The Royal College of Surgeons in Ireland.
authors.forename: A L Martins
authors.initials: AL
authors.lastname: de Oliveira
authors.affiliation: Professor and Head of the School of Nursing and Midwifery, The Royal College of Surgeons in Ireland.
authors.forename: Z
authors.initials: Z
authors.lastname: Moore
mesh_terms: D002370:Casts, Surgical; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D003668:Pressure Ulcer / Q000517:prevention & control* / Q000628:therapy*; D012775:Shoes; D016474:Weight-Bearing; D014945:Wound Healing
keywords: diabetes mellitus; diabetic foot; diabetic foot ulcer; offloading; systematic review