Application Status of Offloading Interventions in Patients with Diabetic High-Risk Foot: A Scoping Review

According to the definition of the International Working Group on the Diabetic Foot (IWGDF) , a diabetic high-risk foot refers to a foot in patients with diabetes without active ulceration but with severe peripheral neuropathy or peripheral arterial disease, regardless of the presence of foot deformity, a history of foot ulceration, or amputation. Over the lifetime of patients with a diabetic high-risk foot, the probability of developing a DFU is 19-34%, and even upon entering DFU remission, the one-year recurrence rate is as high as 40% . The appropriate use of offloading interventions can prevent the progression from a diabetic high-risk foot to a DFU. Offloading interventions are applicable to patients with a diabetic high-risk foot and those with healed ulcers. They function by reducing the mechanical stress on the plantar foot, a combination of plantar pressure and shear forces, to prevent ulcer formation and progression, thereby lessening the burden on patients and their families. This article presents a scoping review of the current application status of offloading interventions in patients with a diabetic high-risk foot both domestically and internationally, aiming to provide a reference for its clinical application in the care of diabetic foot patients in China. 1 Materials and Methods 1.1 Identifying the Research Questions Using the JBI methodology for scoping reviews as the methodological framework, the review questions included: What are the types and indications for the application of offloading devices in the care of patients with diabetic foot? What are the evaluation criteria and effects of their application? 1.2 Inclusion and Exclusion Criteria Inclusion and exclusion criteria were determined according to the PCC principle: ① Population (P): Patients with a diabetic high-risk foot who meet the indications for using offloading devices; ② Concept (C): Offloading devices; ③ Context (C): The use of offloading devices to prevent the progression of a diabetic high-risk foot or the recurrence of foot ulcers; ④ Study designs included randomized controlled trials, quasi-experimental studies, cohort studies, and case-control studies. Exclusion criteria were: ① Non-Chinese or non-English articles; ② Publication types such as study protocols, guidelines, reviews, opinions, conference abstracts, or proposals; ③ Full text not available. 1.3 Search Strategy A computerized systematic search was conducted in seven databases: Web of Science, PubMed, Embase, Science Direct, CNKI, Wanfang Data, and VIP. The search period was from the inception of each database to December 2025. The research topics were identified as "offloading intervention" and "diabetic high-risk foot". Taking the English search strategy as an example: #1 "Diabetic Angiopathies"[Mesh] OR "Diabetic Angiopathy"[Abstract] OR "Diabetic Vascular Diseases"[Abstract] OR "Peripheral Arterial Disease"[Mesh] OR "Lower Limb Ischemia"[Abstract] #2 "Diabetic Neuropathies"[Mesh] OR "Diabetic Neuropathy"[Abstract] OR "Diabetic Peripheral Neuropathy"[Abstract] #3 "Foot"[Mesh] OR "Foot Deformities"[Mesh] OR "Biomechanical Phenomena"[Mesh] OR "Gait"[Mesh] OR "Plantar Pressure"[Title/Abstract] OR "Foot Deformities"[Abstract] OR "Charcot Foot"[Abstract] OR "Hammer Toe"[Abstract] OR "Hallux Valgus"[Abstract] #4 "Diabetic Foot"[Mesh] OR "Foot Ulcer"[Mesh] OR "High-Risk Foot"[Title/Abstract] OR "Pre-Ulcerative Foot"[Abstract] #5 "Shoes"[Mesh] OR "Orthotic Devices"[Mesh] OR "Casts, Surgical"[Mesh] OR "Offloading Shoes"[Title/Abstract] OR "Prescription therapeutic footwear"[Title/Abstract] OR "Removable cast walker"[Title/Abstract] OR "Total contact cast"[Title/Abstract] OR "cushioned insole"[Title/Abstract] OR "rigid rocker"[Title/Abstract] #6 (#1 OR #2) AND #3 AND #4 AND #5 1.4 Literature Screening and Data Extraction Literature screening was independently conducted by two researchers who had received evidence-based training and passed relevant assessments. Based on the inclusion and exclusion criteria, screening was performed using Zotero 7.0 reference management software. In case of disagreements, a discussion with a third reviewer was held to decide on inclusion. The data extracted from the literature included author(s), country, year of publication, study population, sample size, type of offloading intervention, intervention duration, and outcome measures.