Gutekunst David J, Hastings Mary K, Bohnert Kathryn L, Strube Michael J, Sinacore David R
Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School School of Medicine, St. Louis, MO 63110, USA.
Clin Biomech (Bristol). 2011 Jul;26(6):649-54. doi: 10.1016/j.clinbiomech.2011.03.010. Epub 2011 Apr 14.
Elevated plantar loading has been implicated in the etiology of plantar ulceration in individuals with diabetes mellitus and peripheral neuropathy. Total contact casts and cast walker boots are common off-loading strategies to facilitate ulcer healing and prevent re-ulceration. The purpose of this study was to compare off-loading capabilities of these strategies with respect to plantar loading during barefoot walking.
Twenty-three individuals with diabetes, peripheral neuropathy, and plantar ulceration were randomly assigned to total contact cast (n=11) or removable cast walker boot (n=12). Each subject underwent plantar loading assessment walking barefoot and wearing the off-loading device. Analysis of covariance was used to compare loading patterns in the off-loading devices for the whole foot, hindfoot, midfoot, and forefoot while accounting for walking speed and barefoot loading.
For the foot as a whole, there were no differences in off-loading between the two techniques. Subjects wearing cast walker boots had greater reductions in forefoot peak pressure, pressure-time integral, maximum force, and force-time integral with respect to barefoot walking. Healing times were similar between groups, but a greater proportion of ulcers healed in total contact casting compared to cast walker boots.
In subjects with diabetes, peripheral neuropathy, and plantar ulceration, cast walker boots provided greater load reduction in the forefoot, the most frequent site of diabetic ulceration, though a greater proportion of subjects wearing total contact casts experienced ulcer healing. Taken together, the less effective ulcer healing in cast walker boots despite superior forefoot off-loading suggests an important role for patient compliance in ulcer healing.
足底负荷增加与糖尿病和周围神经病变患者足底溃疡的病因有关。全接触石膏和可拆卸石膏步行靴是促进溃疡愈合和预防溃疡复发的常用减负策略。本研究的目的是比较这些策略在赤足行走时的足底负荷减负能力。
23例患有糖尿病、周围神经病变和足底溃疡的患者被随机分为全接触石膏组（n = 11）或可拆卸石膏步行靴组（n = 12）。每位受试者在赤足行走和穿戴减负装置时接受足底负荷评估。采用协方差分析比较减负装置在全足、后足、中足和前足的负荷模式，同时考虑步行速度和赤足负荷。
对于整个足部，两种技术在减负方面没有差异。与赤足行走相比，穿戴石膏步行靴的受试者前足峰值压力、压力-时间积分、最大力和力-时间积分的降低幅度更大。两组的愈合时间相似，但与石膏步行靴相比，全接触石膏治疗的溃疡愈合比例更高。
在患有糖尿病、周围神经病变和足底溃疡的受试者中，石膏步行靴在前足（糖尿病溃疡最常见的部位）提供了更大的负荷减轻，尽管穿戴全接触石膏的受试者溃疡愈合比例更高。综上所述，尽管石膏步行靴在前足减负方面效果更佳，但溃疡愈合效果较差，这表明患者依从性在溃疡愈合中起着重要作用。
