Skip Navigation LinksHome > July 2014 - Volume 27 - Issue 7 > Diabetic Foot Ulcer Off-loading: The Gap Between Evidence an...
Advances in Skin & Wound Care:
doi: 10.1097/01.ASW.0000450831.65667.89
Features: Original Investigations

Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and Practice. Data from the US Wound Registry

Fife, Caroline E. MD; Carter, Marissa J. PhD; Walker, David CHT; Thomson, Brett MS; Eckert, Kristen A. MPhil

Collapse Box


OBJECTIVE: To evaluate the practice of off-loading diabetic foot ulcers (DFUs) using real-world data from a large wound registry to better identify and understand the gap between evidence and practice.

DESIGN: Retrospective, deidentified data were extracted from the US Wound Registry based on patient/wound characteristics, procedures performed, and at which clinic the DFU was treated.

SETTING: 96 clinics (23 from the United States and Puerto Rico)

PATIENTS: 11,784 patients; 25,114 DFUs

MAIN OUTCOME MEASURES: Healed/not healed, amputated, percent off-loading, percent use of total contact casting (TCC), infection rate

MAIN RESULTS: Off-loading was documented in only 2.2% of 221,192 visits from January 2, 2007, to January 6, 2013. The most common off-loading option was the postoperative shoe (36.8%) and TCC (16.0%). There were significantly more amputations within 1 year for non-TCC–treated DFUs compared with TCC-treated DFUs (5.2% vs 2.2%; P = .001). The proportion of healed wounds was slightly higher for TCC-treated DFUs versus non-TCC–treated DFUs (39.4% vs 37.2%). Infection rates were significantly higher for non-TCC–treated DFUs compared with TCC-treated DFUs (2.6 vs 1.6; P = 2.1 × 10−10). Only 59 clinics used TCC (61%); 57% of those clinics used traditional TCC, followed by TCC-EZ (36%). Among clinics using any type of TCC, 96.3% of the DFUs that did not receive TCC were “TCC-eligible” ulcers. Among clinics using “traditional” TCC systems, 1.4% of DFUs were treated with TCC, whereas clinics using TCC-EZ provided TCC to 6.2% of DFUs.

CONCLUSION: Total contact casting is vastly underutilized in DFU wound care settings, suggesting that there is a gap in practice for adequate off-loading. New, easier-to-apply TCC kits, such as the TCC-EZ, may increase the frequency with which this ideal form of adequate off-loading is utilized.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. All world rights reserved.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.