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Xi Zhang,1,* Hongyan Wang,1,* Chenzhen Du,1 Xiaoyun Fan,2 Long Cui,3 Heming Chen,4 Fang Deng,5 Qiang Tong,6 Min He,7 Mei Yang,8 Xingrong Tan,9 Lin Li,10 Zerong Liang,11 Yaqin Chen,12 Deqing Chen,13 David G Armstrong,14 Wuquan Deng1 1Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, Peopleâs Republic of China; 2Department of Endocrinology, Hospital for Occupational Diseases of Chongqing, Chongqing, Peopleâs Republic of China; 3Department of Endocrinology, Armed Police Hospital of Chongqing, Chongqing, Peopleâs Republic of China; 4Department of Endocrinology, Ankang Central Hospital, Ankang, Shaanxi, Peopleâs Republic of China; 5Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, Peopleâs Republic of China; 6Department of Endocrinology, Chongqing Xinqiao Hospital, Chongqing, Peopleâs Republic of China; 7Department of Endocrinology, The Peopleâs Hospital of Shapingba District, Chongqing, Peopleâs Republic of China; 8Department of Endocrinology, The First Peopleâs Hospital of Chongqing Liangjiang New Area, Chongqing, Peopleâs Republic of China; 9Department of Endocrinology, The 9th Peopleâs Hospital of Chongqing, Chongqing, Peopleâs Republic of China; 10Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Peopleâs Republic of China; 11Department of Endocrinology, Chongqing Red Cross Hospital, Peopleâs Hospital of Jiangbei District, Chongqing, 400020, Peopleâs Republic of China; 12Department of Endocrinology, The Peopleâs Hospital of Shizhu, Chongqing, Peopleâs Republic of China; 13Department of Endocrinology, The Peopleâs Hospital of Rongchang, Chongqing, Peopleâs Republic of China; 14Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA*These authors contributed equally to this workCorrespondence: Wuquan Deng Email wuquandeng@cqu.edu.cnBackground: Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapyâs clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions.Methods: A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy.Results: Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up.Conclusion: Patientsâ adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.Keywords: custom-molded offloading footwear, high-risk diabetic foot, patient adherence |
