COMPARISON OF STRATEGIES FOR REDUCING PRESSURE AT THE SITE OF NEUROPATHIC ULCERS

Few scientific data are available on the effectiveness of commonly use d modalities for reducing pressure at the site of neuropathic ulcers i n persons with diabetes mellitus. The authors' aim was to compare the effectiveness of total contact casts, half-shoes, rigid-soled postoper ative shoes, accommodative dressings made of felt and polyethylene foa m, and removable walking casts in reducing peak plantar foot pressures at the site of neuropathic ulcerations in diabetics. Using an in-shoe pressure-measurement system, data from 32 midgait steps were collecte d for each treatment. There was a consistent pattern in the devices' e ffectiveness in reducing foot pressures at ulcer sites under the great toe and ball of the foot. Removable walking casts were as effective a s or more effective than total contact casts. Half-shoes were consiste ntly the third most effective modality, followed by accommodative dres sings and rigid-soled postoperative shoes.