Removable and non-removable offloading devices: A plantar pressure analysis

Background: Diabetic foot ulcers are associated with a twelve-fold increased risk of lower extremity amputations and increased mortality rates. Offloading is one of the many crucial interventions involved in healing diabetic foot ulcers. This study will investigate various offloading devices; total contact casts (TCC), a removable TCC (R-TCC) with and without brace, removable controlled ankle motion walker (RCW), with further subdivision of plantar foot regions.
Methods: Previously collected de-identified data of twelve healthy participants from Bhatt et al. was utilised in this present study. PPP of nine individual mask regions for each offloading device were imported into Statistical Package for the Social Sciences (v.25, SPSS Inc., Chicago, IL) for analysis.
Results: RCW, TCC and R-TCC with brace had significant PPP reduction compared to control in eight out of nine regions of the foot, except for the non-significant increase in PPP of the medial midfoot region. R-TCC with brace had a non-significant peak plantar pressure reduction difference when compared against the TCC for six out of nine regions. Conclusions: In conclusion, this study found new discoveries by further expanding on studies by Bhatt et al. and subdividing the plantar foot into nine regions. TCC remains the gold standard and first line of treatment for offloading diabetic foot ulcers. These findings contradict those previously reported by Bhatt et al.