Background: Off-loading is essential for diabetic foot management, but remains understudied. The evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) trial aims to evaluate the efficacy of a new removable device “Orthèse Diabète” in the healing of diabetic foot.
Methods/design: ORTHODIAB is a French multi-centre randomized, open label trial, with a blinded end points evaluation by an adjudication committee according to the Prospective Randomized Open Blinded End-point. Main endpoints are adjudicated based on the analysis of diabetic foot photographs. Orthèse Diabète is a new removable off-loading orthosis (PROTEOR, France) allowing innovative functions including real-time evaluation of off-loading and estimation of patients’ adherence. Diabetic patients with neuropathic plantar ulcer or amputation wounds (toes or transmetatarsal) are assigned to one of 2 parallel-groups: Orthèse Diabète or control group (any removable device) according to a central computer-based randomization. Study visits are scheduled for 6 months (days D7 and D14, and months M1, M2, M3, and M6). The primary endpoint is the proportion of patients whose principal ulcer is healed at M3. Secondary endpoints are: the proportion of patients whose principal ulcer is healed at M1, M2 and M6; the proportion of patients whose initial ulcers are all healed at M1, M2, M3, and M6; principal ulcer area reduction; time-related ulcer-free survival; development of new ulcers; new lower-extremity amputation; infectious complications; off-loading adherence; and patient satisfaction. The study protocol was approved by the French National Agency for Medicines and Health Products Safety, and by the ethics committee of Saint-Louis Hospital (Paris). Comprehensive study information including a Patient Information Sheet has been provided to each patient who must give written informed consent before enrolment. Monitoring, data management, and statistical analyses are providing by UMANIS Life Science (Paris), independently to the sponsor. Since 27/10/2013, 13 centres have agreed to participate in this study, 117 participants were included, and 70 have achieved the study schedules. The study completion is expected for the end of 2016, and the main results will be published in 2017.
Conclusion: ORTHODIAB trial evaluates an innovating removable off-loading device, seeking to improve diabetic foot healing (ClinicalTrials.gov identifier: NCT01956162).
Keywords: Diabetic foot, Wound, Healing, Off-loading, Device
Abbreviations: AEs, Adverse events; ANSM, French national agency for medicines and health products safety agency; ICC, Intraclass correlation coefficients; ORTHODIAB, Evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot; PROBE, Prospective randomized open blinded end-point; QUEST, Quebec user evaluation of satisfaction with assistive technology survey; RCT, Randomized controlled trials; SAE, Serious AEs; SPIRIT, Standard protocol items: recommendations for interventional trials; TCC, Total contact cast.
Diabetic foot is a major public health problem worldwide . It is associated with poor survival and functional outcomes with a high rate of recurrence [2–6]. Diabetic foot is a leading cause of lower-extremity amputation  with fifty percent of non-traumatic amputations practiced in patients with diabetes [7, 8]. Diabetic foot is characterized by a slow and difficult healing with high risk of amputation and infectious disease . Increased plantar pressure is the most important factor for the development of plantar ulcers in diabetic patients [9, 10].