REDUCING DYNAMIC FOOT PRESSURES IN HIGH-RISK DIABETIC SUBJECTS WITH FOOT ULCERATIONS - A COMPARISON OF TREATMENTS

OBJECTIVE - To compare the effectiveness of total contact casts, comme rcially available therapeutic shoes, and removable walking casts to re duce mean peak plantar foot pressures at the site of neuropathic ulcer ations in diabetic subjects. RESEARCH DESIGN AND METHODS - We compared the reduction in peak plantar pressures at ulcer sites under the grea t toe (n = 5), first metatarsal (n = 10), and second through fifth met atarsals (n = 10) using six treatments: total contact casts (TCCs), DH Pressure Relief Walkers (DH), Aircast Pneumatic Walkers, Three D Dura -Steppers (3D), CAM Walkers, and P.W. Minor Xtra Depth shoes. A rubber sole canvas oxford was used to establish baseline pressure values. Th e canvas oxford could be viewed as a worse-case scenario for this pati ent population. With the EMED Pedar in-shoe pressure measurement syste m, data for 40 steps were collected for each treatment. We used Tukey' s Studentized Range Test for simultaneous multiple comparisons to comp are treatments. RESULTS - DH Pressure Relief Walkers reduced plantar p ressures significantly better than other commercially available treatm ents for ulcers under the first metatarsal, second through fifth metat arsals, and great toe (P < 0.05). There was not a significant differen ce in mean peak plantar pressures between TCCs and DHs at any of the f orefoot ulcer sites. CONCLUSIONS - DH Pressure Relief Walkers were as effective as total contact casts to reduce foot pressures at ulcer sit es and may be an effective practical addition in the treatment of foot ulcers.