LEEDer Group Inc.
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2015-02 Optimal-Consensus Use for Off-Loading DFUs-e.g. KYDEX PRO





Industry Review // Advances

Optimal Use of Off-Loading in Diabetes-Related Foot Ulcer Treatment: Guidelines and Recommendations
  • A group of nine multidisciplinary experts have developed a consensus statement of guidelines and recommendations for off-loading in the management of diabetes-related foot ulcers (DFUs). The document was developed to provide evidence-based consensus on the optimal use of off-loading as treatment for DFUs. After conducting a Pub Med literature review of about 90 studies for evidence about off-loading of foot ulcers, the authors drafted the statements and recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of evidence and develop strength of recommendations for each consensus statement. They concluded that adherence with off-loading increases the likelihood DFUs will heal and reduces complications [emphasis added], such as amputations, and that current evidence favors the use of non-removable casts or affixed ankle walking braces [e.g KYDEX PRO Ambulation brace, Stronger-Safer for ambulation induced blood flow, which is critical to improvement] as optimum off-loading modalities. However, they noted that an increase in clinician use of effective off-loading is necessary.

  • “Publishing this paper is intended to bridge the gap between evidence supporting the effectiveness of off-loading for diabetic foot ulcers and its use in clinical practice, and to guide the wound care decision-making process,â€? said Robert J. Snyder, DPM, MSc, professor and director of clinical research at Barry University School of Podiatric Medicine, and lead author of the guidelines
  • Consensus Statement 1:
    The VIPs (vascular management, infection management and prevention, and pressure relief) are essential to DFU healing.
  • Consensus Statement 2:
    Adequate off-loading increases the likelihood of DFU healing.
  • Consensus Statement 3:
    For guidance on off-loading the Charcot foot, the panel endorses “the Charcot Foot in Diabetes� consensus report published in 2011 (Diabetes Care,vol. 34).
  • Consensus Statement 4:
    Total contact casting is the preferred method for off-loading plantar DFUs, as it has most consistently demonstrated the best healing outcomes and is a cost-effective treatment.
  • Consensus Statement 5:
    There currently exists a gap between the evidence supporting the efficacy of DFU off-loading and what is performed in clinical practice.
  • Consensus Statement 6:
    The likelihood of DFU healing is increased with off-loading adherence.
  • Consensus Statement 7:
    Advanced therapeutics are unlikely to succeed in improving wound-healing outcomes unless effective off-loading is obtained. [e.g. KYDEX-PRO ambulation boot L4396 or L4397 / L1930] KYDEX PRO Multi Podus
  • Consensus Statement 8:
    The panel supports the development of a per visit off-loading quality measure to address the gap between evidence of off-loading and its current use in clinical practice.