| Summary: | Diabetic offloading devices are used to treat or prevent foot ulcers. Their purpose is to redistribute pressure on plantar surfaces thereby reducing the risk of foot ulcers and infection. Common offloading modalities include removable cast walkers and total contact casting. For example, total contact casting uses fibreglass or plaster to support lower legs by redistributing pressure from ulcer to the entire foot. Redistributing pressure helps to manage swelling and reduces the risk of foot infections. Total contact casting and removable cast walkers appear to be clinically effective. One systematic review of randomized controlled trials found that healing rates for patients who were treated by total contact casting was between 74% and 95%, and for removable cast walkers was 52% and 85%. However, there are issues pertaining to adherence to offloading, which may explain the difference between the effectiveness of total contact casting and removable cast walkers. Given the important role offloading devices can play in treating or preventing diabetic foot ulcers, there is a need to clarify the challenges patients with diabetes face adhering to different devices. This rapid qualitative evidence synthesis analyzes the perspectives, experiences, and preferences of patients with diabetes and of podiatrists using offloading devices for the treatment of diabetic foot ulcers
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