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PODUS 2020 has the most favorable accuracy and clinical feasibility characteristics of all existing models/tools for predicting diabetic foot ulcer (DFU) development (at 2 years). No tools to predict outcome of a DFU over a specified time horizon were identified. Due to significant methodological limitations in the primary literature and systematic reviews, the comparative effectiveness of orthotics and pedorthic interventions for preventing and treating DFUs is uncertain.
DFUs are common in veterans, and associated with morbidity, mortality, and increased health-care costs. Tools for predicting DFU development or outcome may aid in targeted interventions, including use of orthotics/pedorthics, focused on high-risk veterans. Hence, we conducted a review of reviews of prognostic tools to assess risk of DFU development and outcome, and orthotic and pedorthic interventions for prevention and treatment of DFUs.
We identified 30 relevant systematic reviews; the risk of bias was low for 15 reviews, moderate for 7, and high for 8. Only 5 of the 30 systematic reviews were restricted to RCTs. Of the identified prognostic tools, PODUS 2020 predicting DFU development at 2 years, had the most favorable accuracy and clinical feasibility characteristics. However, this tool has not been validated in veterans and no data exist to inform appropriate re-screening intervals. There were no tools for prediction of amputation or non-healing in patients with a current DFU over a specified time horizon. There were significant methodological limitations in the literature on the comparative effectiveness of orthotics and pedorthic interventions for preventing and treating DFUs. However, limited evidence suggests that offloading and therapeutic footwear may be effective in preventing DFUs, and accommodative insoles, Total Contact Casts, and available removable devices may improve DFU healing. However, intervention adherence was low and research to identify adherence barriers and facilitators is needed.
Prognostic Tools and Interventions to Prevent and Treat Diabetic Foot Ulcers: A Review of Reviews (Management Brief)
Kaka AS, Landsteiner A, Ensrud KE, et al. Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews. Journal of Foot and Ankle Research. 2023;16(13). DOI: https://doi.org/10.1186/s13047-023-00610-6.