Article

Non-removable knee-high devices, such as a total contact cast (TCC),
are recommended for offloading diabetic plantar forefoot ulcers. However, it is
insufficiently known how each of the different design characteristics of these
devices contribute to offloading the diabetic foot.
RESEARCH : What is
the offloading effect of the different design characteristics that make up a
non-removable knee-high cast for people with diabetes and active or previous
plantar forefoot ulcers ? METHODS: Sixteen persons with diabetes, peripheral
neuropathy and a healed or active plantar forefoot ulcer had their plantar
pressures measured during walking in a non-removable knee-high device (TCC), in
that device made removable (BTCC), in that device made below-ankle (cast shoe),
in that cast shoe worn with a different walking sole and in a newly made cast
shoe without a custom-moulded foot-device interface. Peak pressures, force-time
integral, and perceived walking comfort were assessed. RESULTS: Compared with the
BTCC, peak pressures in the TCC were 47% (P=0.028), 26% (P=0.003) and 15%
(P=0.050) lower at the hallux, midfoot and (previous) ulcer location,
respectively. Compared to the cast shoe, peak pressures in the BTCC were 39-43%
and 47% (both P<0.001) lower in the forefoot regions and (previous) ulcer
location, respectively. The total force-time integral was 21% and 11% (P<0.007)
lower in the TCC and BTCC compared to the cast shoe. Perceived walking comfort
was 5.6 in the TCC and 6.5 in the BTCC (P=0.037). Effects of the other design
characteristics (i.e. walking sole and plantar moulding) were non-significant.
SIGNIFICANCE: The TCC gives superior offloading, mostly because of being a
knee-high and non-removable device, providing an optimal 'shaft effect'. The TCC
does, however, negatively affect walking comfort.
These results aid
decision-making in offloading diabetic plantar forefoot ulcers.
CI - Copyright (c) 2018 Elsevier B.V. All rights reserved.

Langue : ANGLAIS