Offloading effects of a removable cast walker with and without modification for diabetes-related foot ulceration: a plantar pressure study
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 condi- tion), 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 ran- domised trials are now needed to evaluate the effectiveness of this device for healing DRFUs.
Keywords Diabetic foot, Foot ulcer, Pressure, Plantar pressure, Kinetics, Offloading, Orthotic devices, Felt padding, Removable cast walker