Removable and Nonremovable Off-Loading Devices.

Background: Diabetic foot ulcers are associated with a 12-fold increased risk of lower-extremity amputations and increased mortality rates. Off-loading is one of the many crucial interventions involved in healing diabetic foot ulcers. This study investigates various off-loading devices: total-contact cast (TCC), removable TCC (R-TCC) with and without brace, and removable controlled ankle motion walker, with further subdivision of plantar foot regions.

Methods: Previously collected deidentified data of 12 healthy participants from a study by Bhatt et al were used in the present study. Peak plantar pressure (PPP) of nine individual mask regions for each off-loading device were imported into a statistical software program for analysis.

Results: Removable controlled ankle motion walker, TCC, and R-TCC with brace had significant PPP reductions compared with controls in eight of the nine regions of the foot, except for the nonsignificant increase in PPP of the medial midfoot region. The R-TCC with brace had a nonsignificant PPP reduction difference compared with the TCC for six of the nine regions.

Conclusions: This study found new discoveries by further expanding on studies by Bhatt et al and subdividing the plantar foot into nine regions. The TCC remains the gold standard and first line of treatment for off-loading diabetic foot ulcers. These findings contradict those previously reported by Bhatt et al.