Offloading effects of a removable cast walker with and without modification for diabetes-related foot ulceration: a plantar pressure study

Rebekah V Withers; Byron M Perrin; Karl B Landorf; Anita Raspovic

doi:10.1186/s13047-023-00625-z

Offloading effects of a removable cast walker with and without modification for diabetes-related foot ulceration: a plantar pressure study

J Foot Ankle Res. 2023 May 11;16(1):27. doi: 10.1186/s13047-023-00625-z.

Authors

Rebekah V Withers¹, Byron M Perrin², Karl B Landorf¹, Anita Raspovic³

Affiliations

¹ Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia.
² La Trobe Rural Health School, La Trobe University - Bendigo Campus, Flora Hill, 3552, Australia.
³ Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia. a.raspovic@latrobe.edu.au.

Abstract

Background: Removable cast walkers (RCWs), with or without modifications, are used to offload diabetes-related foot ulcers (DRFUs), however there is limited data relating to their offloading effects. This study aimed to quantify plantar pressure reductions with an RCW with and without modification for DRFUs.

Methods: This within-participant, repeated measures study included 16 participants with plantar neuropathic DRFUs. Walking peak plantar pressures at DRFU sites were measured for four conditions: post-operative boot (control condition), RCW alone, RCW with 20 mm of felt adhered to an orthosis, and RCW with 20 mm of felt adhered to the foot.

Results: Compared to the control condition, the greatest amount of peak plantar pressure reduction occurred with the RCW with felt adhered to the foot (83.1% reduction, p < .001). The RCW with felt adhered to the foot also offered greater peak plantar pressure reduction than the RCW alone (51.3%, p = .021) and the RCW with felt adhered to an orthosis (31.4%, p = .009).

Conclusion: The largest offloading effect recorded was with the RCW with felt adhered to the foot. High-quality randomised trials are now needed to evaluate the effectiveness of this device for healing DRFUs.

Keywords: Diabetic foot; Felt padding; Foot ulcer; Kinetics; Offloading; Orthotic devices; Plantar pressure; Pressure; Removable cast walker.

MeSH terms

Diabetes Mellitus*
Diabetic Foot* / therapy
Foot
Foot Ulcer*
Humans
Walkers
Walking