The Use of Multilayer Felt Padding in the Treatment of Neuropathic Plantar Foot Ulcerations.

Background: Neuropathic plantar foot ulcers are difficult to treat due to their location and the repetitive pressures applied during ambulation. Total-contact casts and removable off-loading devices are effective in off-loading pressures; however, patient intolerance and adherence are barriers to use. Felt padding can provide off-loading with greater tolerance. We present novel felt padding techniques that provide off-loading with greater adherence and may ultimately lead to greater rates of wound closure.

Methods: This retrospective study included patients with neuropathic plantar foot ulcers seen at a single center between August 1, 2016 and July 15, 2020. Felt padding was applied to the plantar foot during clinic visits. Ulcer characteristics, medical history, and treatment options were extracted and evaluated. Statistical analyses were performed with descriptive statistics, two-sample t tests, and Fisher exact tests. Kaplan-Meier method was used to estimate time to reach 50% ulcer surface area reduction.

Results: Of 59 included patients with neuropathy and a plantar foot ulcer treated with felt padding, 46 (78.0%) had diabetes mellitus. Mean ± SD surface area was 1.0 ± 1.8 cm2. Mean ± SD and median (interquartile range) healing times were 67.4 ± 76.3 days and 45 (40) days, respectively. The percentage healed by 12 weeks was 78.0%. There was no significant difference in healing times between diabetic and nondiabetic patients (P = .57).

Conclusions: Multilayer felt padding is an important adjunctive tool for off-loading and healing of neuropathic plantar foot ulcers. Use of multilayer felt off-loading padding should be considered for patients with suspected low adherence to wearing a removable knee-high or ankle-high off-loading device.