Research Week Abstract Book - Northern Health

Health Service Evaluation
Northern Health Guideline for the Offloading Management of
Plantar Neuropathic Foot Ulcers: Development and Evaluation
Health SERVICE EVALUAtion
Harper K, Steel A, Spring A, Gazarek J.
Background
The treatment and prevention of plantar neuropathic foot ulceration (PNFU) involves a holistic approach which addresses
factors affecting healing and ulcer recurrence. Integral to this is the adequate reduction of plantar pressures with appropriate
offloading modalities. A guideline was developed to direct the offloading interventions for Northern Health (NH) Podiatrists
and Orthotists and its use was evaluated.
Aim
The aim of the project was to develop an evidence based guideline to direct the offloading management of PNFUs for NH
Podiatrists and Orthotists.
Methodology
A literature review was completed to assess the evidence base on selection and use of offloading devices for the treatment
and prevention of PNFUs. Knowledge of the experienced clinicians was also incorporated to address important patient
factors with offloading treatments. The guideline was launched with education workshops to ensure effective implementation
of best practice offloading. A file audit of NH patients with PNFUs was conducted evaluating the use of offloading devices
prior to the implementation of the guideline, and repeated 3 months
post implementation. A survey was conducted to evaluate clinician knowledge and use of appropriate offloading interventions
before and after the guideline was introduced.
Results
The literature review found that devices that reduce foot plantar pressures, control ankle joint range of motion and are
irremovable; are the most effective in achieving optimal ulcer healing outcomes. The guideline incorporated this with clinician
expertise to direct the short, medium and long term goals of offloading. After implementation of the guideline, there was a
trend toward a more co-ordinated transitional approach with an increased use of higher level and more appropriate devices in
line with best practice, an improvement in clinicians’ knowledge and use of appropriate offloading devices for PNFU.
Conclusion
The Offloading Guideline for Plantar Neuropathic Foot Ulceration facilitates evidence based practice to guide the selection of
offloading devices for NH Podiatry and Orthotics patients.
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