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Document Type

Conference Proceedings

Abstract

Objective: Partial weight-bearing (PWB) strategies are central to off-loading in diabetes, yet guidance on how to operationalize PWB across devices and exercise programs remains inconsistent. We synthesized evidence on PWB modalities for adults with diabetes and plantar ulcers or diabetic peripheral neuropathy. Methods: We conducted a PRISMA‑2020 systematic review of English‑language randomized or prospective studies (≥4 weeks; 2010–July 2025) evaluating defined weight‑bearing/off‑loading strategies versus standard care or alternatives, with outcomes including healing, time‑to‑heal, plantar‑pressure metrics, activity/adherence, or complications. Paired reviewers screened/extracted with consensus resolution. Results: Nineteen studies met criteria across three modality clusters: (1) footwear/insoles (including sensor‑enabled), (2) knee‑high casts and removable off‑loading devices, and (3) structured weight‑bearing exercise. Non‑removable knee‑high devices yielded the fastest healing and highest healing rates; outcomes with removable devices were constrained by adherence. Optimized footwear reduced plantar pressures and ulcer recurrence. Exercise programs improved function and were associated with lower recurrence in prevention cohorts. Conclusions: For active ulcer healing, non‑removable knee‑high devices remain the most effective option; when removable devices are used, adherence is pivotal. For prevention and functional recovery, structured weight‑bearing exercise and optimized footwear are promising adjuncts. Heterogeneity in PWB definitions and protocols underscores the need for standardized dosing and adequately powered trials.

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