Polyurethane foam sheets for relieving pressure from diabetic neuropathic plantar ulcers: a pilot study

INTRODUCTION: Lesions of the diabetic neuropathic foot are mainly caused by pressure in anatomically altered areas. This leads to hyperkeratosis, skin disruption and finally to ulcerations that can progress to underlying bone . Therapy for plantar neuropathic ulcerations in diabetic patients involves relieving pressure from ulcerated areas to allow reepithelialization, Trad itional methods, such as casts, orthoses and special shoes, are not well to lerated by patients. OBJECTIVE: To test whether polyurethane foam sheets, regularly used for dre ssing neuropathic ulcers of the diabetic foot, may also play a role in pres sure relieving, we conducted a pilot study in a group of neuropathic diabet ic outpatients, METHODS: Ten diabetic patients with non-complicated neuropathic plantar ulc erations were consecutively selected among the attenders of our diabetic fo ot clinic, The patients underwent careful debridement of the ulcerated area and elimination of perilesional hyperkeratosis. The ulcers were then cover ed with semipermeable film allow measurements to De made. An evaluation of static and dynamic plantar pressure was then performed with F-SCAN(R), spec ialized software that analyses data collected from two 960-LED insoles (one for each foot), Static plantar pressures were acquired after patients had stood still on both feet for 15 s, while dynamic pressures were measured af ter walking for 2 min. The same evaluations were performed after positionin g over and around the ulcers a double layer of polyurethane foam sheeting ( Allevyn Adhesive(R)) tailored to adapt to the conformation of the foot, The following parameters were then evaluated: peak pressure (PP: kPa); areas o f peak pressure (APP: cm(2)); time of application of peak pressure (TPP: s) , RESULTS: The PP was significantly lower after application of the polyuretha ne sheeting (P < 0.01), while the APP significantly increased (P < 0.001), No significant differences were observed for TPP. Differences in PP (Delta PP) and in APP (Delta APP) were then calculated: Delta PP significantly inv ersely correlated with Delta APP, both in static and in dynamic conditions (P < 0.001). CONCLUSION: Polyurethane foam sheets proved to be effective in reducing pla ntar pressures in neuropathic feet, probably because of an increased area o f pressure distribution. Further studies are necessary to verify whether th e use of this material could actually reduce the healing time of neuropathi c ulcers in diabetic patients.