Footwear and offloading interventions to prevent and heal diabetic foot ulcers: Adapted IWGDF guidance

Introduction: Foot ulcer is one of the greatest complications of diabetes. If there is no effective pressure reduction in the ulcer, healing may be delayed. In this regard, the use of offloading methods for the prevention and treatment of foot ulcers in diabetic patients is known as a common therapeutic approach. Since evidence-based recommendations should be considered for the use of the above methods, we decided to provide applicable guidelines in this area by localizing the recommendations and localizing the IWGDF practical guide. Materials and Methods: In this study, the adoption of the international evidence-based clinical guidelines on the offloading interventions to prevent and heal diabetic foot ulcers was carried out using the ADAPTE methodology  in  a working group consisting of orthopedic, physical medicine and rehabilitation specialists was performed during three stages of set up, adoption, and finalization. AGREEII tool was used to evaluate the quality of the selected clinical guidelines. Also, in order to reach a consensus for the relevant recommendations, three Delphi rounds and one face-to-face meeting were used. Results: The IWGDF 2015 clinical guide was selected. The quality score of this guideline based on AGREEII tool in each of the 6 areas was more than 70% and varied between 81.3% and 100% with good quality. The IWGDF guideline for offloading interventions for the prevention and treatment of diabetic foot ulcers included 13 recommendations. Conclusion: In IWGDF guideline, a total of 13 recommendations regarding foot wear and offloading interventions in the prevention and treatment of foot ulcers in patients with diabetes in accordance with the health care system of our country were adapted.