Abstract
Introduction
Diabetic foot syndrome is one of the most dreaded complications in diabetes mellitus. The purpose of this study was to assess the value of different offloading devices compared to walking in barefoot condition and in normal shoes both in healthy subjects and in patients with diabetes and neuropathy.
Methods
Twenty patients with diabetes and polyneuropathy and ten healthy probands were included. Pedobarographic examination was performed in barefoot condition, with sneakers, postoperative shoes, Aircast® Diabetic Pneumatic Walker™ and VACO®diaped. In the diabetic group, a total contact cast was additionally tested.
Results
The most effective reduction of force was achieved by TCC (75%) and VACOdiaped (64.3%) with the VACO®diaped resulting in the most homogeneous distribution of forces all over the foot.
Discussion/Conclusion
A customized device like the TCC is still the most proven offloading device. However, a removable cast walker being based on vacuum pads and a cushioning sole, provides better results concerning force distribution.
Similar content being viewed by others
References
van Acker K, Léger P, Hartemann A, Chawla A, Siddiqui MK (2014) Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review. Diabetes Metab Res Rev 30(8):635–645
WHO Media centre. World Health Organization (2016) Fact sheet N° 213. http://www.who.int/mediacentre/factsheets/fs312/en/. Accessed 20 Nov 2016
Goodridge D, Trepman E, Sloan J, Guse L, Strain LA, McIntyre J, Embil JM (2006) Quality of life of adults with unhealed and healed diabetic foot ulcers. Foot Ankle Int 27(4):274–280
Nabuurs-Franssen MH, Huijberts MS, Nieuwenhuijzen Kruseman AC, Willems J, Schaper NC (2005) Health-related quality of life of diabetic foot ulcer patients and their caregivers. Diabetologia 48(9):1906–1910
Tentolouris N (2010) Chapter 1: introduction. In: Katsilambros N, Dounis E, Makrilakis K, Tentolouris N, Tsapogas P (eds) Atlas of the diabetic foot, 2nd edn. Wiley-Blackwell, West Sussex, p 1
Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL (2013) Comparison of the clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev 29(3):183–193. doi:10.1002/dmrr.2386
Levin ME (1995) Preventing amputation in the patient with diabetes. Diabetes Care 18(10):1383–1394
Caravaggi C, Faglia E, De Giglio R, Mantero M, Quarantiello A, Sommariva E, Gino M, Pritelli C, Morabito A (2000) Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care 23(12):1746–1751
Wu SC, Jensen JL, Weber AK, Robinson DE, Armstrong DG (2008) Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach? Diabetes Care 31(11):2118–2119. doi:10.2337/dc08-0771
Raspovic A, Landorf KB (2014) A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers. J Foot Ankle Res 7:35. doi:10.1186/s13047-014-0035-8
Gray M (2006) Is total contact casting effective for treating diabetic foot ulcers? J Wound Ostomy Continence Nurs 33(4):359–362
de Oliveira AL, Moore Z (2015) Treatment of the diabetic foot by offloading: a systematic review. J Wound Care 24(12):560. doi:10.12968/jowc.2015.24.12.560
Nagel A, Rosenbaum D (2009) Vacuum cushioned removable cast walkers reduce foot loading in patients with diabetes mellitus. Gait Posture 30(1):11–15. doi:10.1016/j.gaitpost.2009.02.007
Bus SA (2012) Priorities in offloading the diabetic foot. Diabetes Metabol Res Rev 28:54–59
Bus SA, van Deursen RW, Armstrong DG, Lewis JE, Caravaggi CF, Cavanagh PR, Foot International Working Group on the Diabetic (2016) Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metab Res Rev 32(Suppl 1):99–118. doi:10.1002/dmrr.2702
Tagawa T, Tamura T, Oberg PA (2011) Chapter 4: motion and force measurements. Biomedical sensors and instruments, 2nd edn. CRC, Boca Raton
Ahroni JH, Boyko EJ, Forsberg R (1998) Reliability of F-scan in-shoe measurements of plantar pressure. Foot Ankle Int 19(10):668–673
Randolph AL, Nelson M, Akkapeddi S, Levin A, Alexandrescu R (2000) Reliability of measurements of pressures applied on the foot during walking by a computerized insole sensor system. Arch Phys Med Rehabil 81(5):573–578
Vidmar G, Novak P (2009) Reliability of in-shoe plantar pressure measurements in rheumatoid arthritis patients. Int J Rehabil Res 32(1):36–40. doi:10.1097/MRR.0b013e328307bdc2
Robinson C, Major MJ, Kuffel C, Hines K, Cole P (2015) Orthotic management of the neuropathic foot: an interdisciplinary care perspective. Prosthetics Orthot Int 39(1):73–81. doi:10.1177/0309364614545422
Lozano-Platonoff A, Florida Mejía-Mendoza MD, Ibáñez-Doria M, Contreras-Ruiz J (2016) The gold standard in diabetic foot treatment: total contact cast. Gac Med Mex 150(1):58–64
Chakraborty PP, Ray S, Biswas D, Baidya A, Bhattacharjee R, Mukhopadhyay P, Ghosh S, Mukhopadhyay S, Chowdhury S (2015) A comparative study between total contact cast and pressure-relieving ankle foot orthosis in diabetic neuropathic foot ulcers. J Diabetes Sci Technol 9(2):302–308
Bejek Z, Paróczai R, Illyés A, Kiss RM (2006) The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 14(7):612–622
Plotnik M, Bartsch RP, Zeev A, Giladi N, Hausdorff JM (2013) Effects of walking speed on asymmetry and bilateral coordination of gait. Gait Posture 38(4):864–869
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
There is no funding source.
Ethical approval
The study protocol was approved by the local ethics committee (University of Regensburg, Ethic Committee Approv. No 10-101-0089)
Informed consent
Informed consent was obtained from all individual participants included in the study
Rights and permissions
About this article
Cite this article
Götz, J., Lange, M., Dullien, S. et al. Off-loading strategies in diabetic foot syndrome–evaluation of different devices. International Orthopaedics (SICOT) 41, 239–246 (2017). https://doi.org/10.1007/s00264-016-3358-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-016-3358-1