Best practice offloading treatments for diabetic foot ulcer healing, remission, and better plans for the healing-remission transition

Diabetes-related foot disease is arguably the world's least known major health problem and causes a disease burden larger than most well-known diseases, such as stroke and breast cancer. This burden is driven by people developing more severe stages of foot disease, such as foot ulcers and infections, and with that worsening quality of life. To reduce this burden, we need treatments that prevent more severe stages of foot disease and improve quality of life. Best practice offloading treatments have been found to be arguably the most effective existing treatments to heal and prevent diabetes-related foot ulcers and infections, but can worsen quality of life. Furthermore, high re-ulceration rates still occur with best practice offloading treatments after healing. This may be because of the gap in guideline recommendations on the transition from ulcer healing to ulcer remission when it comes to offloading treatments. In this paper, we review why we need offloading treatments and what are the best offloading treatments recommended by the latest international guidelines for healing and remission. Further, we propose plans for future best practice offloading treatments for the transition from healing-to-remission to help reduce re-ulceration rates and improve longer-term ulcer remission. These plans could be the catalyst for better transitioning patients from first ulcer presentation through healing and into long-term remission, and in turn delivering better quality of life, and lower diabetes-related foot disease burdens on patients, nations, and the globe in future.