Design innovations: Making Devices to Offload Diabetic Foot Ulcers that our Patients Want to Wear

While no one wants to live with a DFU, perhaps we can make the offloading part a bit less onerous. This is where design thinking comes into play. Doing something “with” our patients and not “to” them is what it’s all about. Here is an interview on this subject focusing on one device. The idea is device agnostic, though.

Hello. I am David G. Armstrong. I am a foot doctor, a toe mechanic if you will. I am a professor of surgery here at the Keck School of Medicine of the University of Southern California in beautiful sunny Los Angeles, where it’s beautifully sunny now but even when it’s not sunny, it’s beautiful and sunny. So hello, it’s great to be with you guys once again.

The technology that we’re talking about today is really, I mean, probably one of the most boring things that we do collectively in limb preservation. We’ve said for the longest time it’s not what you put on these wounds that heals them, but what you take off. And if we take off what’s not viable by debriding the wound, that’s important, that’s one thing to take off. Another thing we need to take off or we need to redistribute is the weight, is the pressure, and we need to spread force out per unit area and this is what we do is podiatric surgeons, as clinicians in general that are dealing with the high risk diabetic foot. And there have been any number of technologies that have helped us to that, probably the most well known, but unfortunately the least used is the total contact cast and that’s still my favorite method of offloading. But my second favorite is probably the second best offloading technology, at least in the past in the lab, and that has been the removable cast walker, there’s an RCW or a removable cast boot. They’re the same thing.

These technologies have been around for now more than 30 years. And you may have heard of the CAM walker people use that as a general term, although that’s actually a brand name for controlled ankle motion, it’s not a very effective method at offloading the foot. But subsequent things to that have become really effective at offloading the foot in the lab because they are about is good at offloading as a total contact cast, the gold standard. And when we make the thing irremovable, then in fact, they seem to behave just about the same way from the data that we have as an ambulatory total contact cast in terms of time to healing.

The trouble leading up to all of this is that many of the devices that we’ve used in the past have been heavy, ugly, and I think, the design for these products could have been a lot better and of course we are hearing this from our patient.

One of the first technologies where they really tried to listen to the patient, focusing on design. And the device I believe is called the defender boot. And it is a removable cast boot, which you can render irremovable if you like. It came out of the work that one of my really good friends, Jason Hanft, who’s a podiatric surgeon, extremely well known podiatric surgeon from Miami. He works with his wife, Maria, and they form a dynamic duo in clinical research down there. And he’s had a chance to really work with a lot of this stuff now, and he’s come up against these same problems. So he developed this along with a designer, most famously for helping to design Air Jordan’s as well as so many other really beautiful technologies.

So this is really the first where intentional design has been brought to bear on a technology to where we can maybe do something with our patients and not to them. Maybe this is one of the first removable cast boots that a doctor would want to wear, or a nurse. And I think that’s kind of cool. So there we have it, that’s kind of the discussion about this and couldn’t be more excited, frankly, as we start to study this technology.




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