To the Editor,

We thank Emilie Dufour and Arnaud Duhoux for taking the time to respond to our article, "The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer: A Randomized Control Study" from the March/April issue of the Journal of Wound, Ostomy and Continence Nursing (JWOCN). We acknowledge that diabetic foot ulcers (DFUs) may be measured using multiple techniques. The Wagner classification system is one of the most commonly used for this and was chosen for this study in part based on its widespread use. We also selected the Wagner system because it is low cost, economic, and readily accessible. In addition, wound assessment was performed by a nurse researcher (SE) with a wound care certificate in order to limit variability. We completed a randomized controlled trial, which is widely accepted as the most appropriate and powerful design for eliminating selection bias. However, despite random allocation of participants, there was a difference between the groups at baseline. We subsequently acknowledged this as a limitation of this study. However, we would like to point out that a decrease in wound size within the group was significant (P < .05). Wound size and depth of the groups were compared between 4.8 and 12 weeks, and there was a significant decrease in the intervention group of the groups themselves (P < .05). We acknowledge the second point that wound measurement methods vary and can influence accuracy and consistency. Finally, we acknowledge offloading as an important recommendation for preventing and treating DFU in diabetic patients. Many factors were identified in the selection of the sample in the study. We limited the participants to those not using offloading in the treatment of their DFU.

Sahizer Erayd[latin dotless i]n, PhD, RN

Health Sciences Faculty, Nursing Department,

Gaziosmanpasa University, Tokat, Turkey