Westra Manon, van Netten Jaap J, Manning Hendrik A, van Baal Jeff G, Bus Sicco A
Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, Almelo, The Netherlands.
Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, Almelo, The Netherlands; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Gait Posture. 2018 Jul;64:90-94. doi: 10.1016/j.gaitpost.2018.05.022. Epub 2018 May 22.
Non-removable knee-high devices, such as a total contact cast (TCC), are recommended for offloading diabetic plantar forefoot ulcers. However, it is insufficiently known how each of the different design characteristics of these devices contribute to offloading the diabetic foot.
What is the offloading effect of the different design characteristics that make up a non-removable knee-high cast for people with diabetes and active or previous plantar forefoot ulcers?
Sixteen persons with diabetes, peripheral neuropathy and a healed or active plantar forefoot ulcer had their plantar pressures measured during walking in a non-removable knee-high device (TCC), in that device made removable (BTCC), in that device made below-ankle (cast shoe), in that cast shoe worn with a different walking sole and in a newly made cast shoe without a custom-moulded foot-device interface. Peak pressures, force-time integral, and perceived walking comfort were assessed.
Compared with the BTCC, peak pressures in the TCC were 47% (P = 0.028), 26% (P = 0.003) and 15% (P = 0.050) lower at the hallux, midfoot and (previous) ulcer location, respectively. Compared to the cast shoe, peak pressures in the BTCC were 39-43% and 47% (both P < 0.001) lower in the forefoot regions and (previous) ulcer location, respectively. The total force-time integral was 21% and 11% (P < 0.007) lower in the TCC and BTCC compared to the cast shoe. Perceived walking comfort was 5.6 in the TCC and 6.5 in the BTCC (P = 0.037). Effects of the other design characteristics (i.e. walking sole and plantar moulding) were non-significant.
The TCC gives superior offloading, mostly because of being a knee-high and non-removable device, providing an optimal 'shaft effect'. The TCC does, however, negatively affect walking comfort. These results aid decision-making in offloading diabetic plantar forefoot ulcers.
不可拆卸的膝上型装置，如全接触石膏（TCC），被推荐用于减轻糖尿病足底前足溃疡的压力。然而，这些装置的不同设计特征如何各自对减轻糖尿病足压力的作用尚不清楚。
对于患有糖尿病且有活动性或既往足底前足溃疡的患者，构成不可拆卸膝上型石膏的不同设计特征的减压效果如何？
16名患有糖尿病、周围神经病变且足底前足溃疡已愈合或仍有活动性溃疡的患者，在穿着不可拆卸膝上型装置（TCC）行走时、该装置变为可拆卸（BTCC）时、该装置变为踝下型（铸鞋）时、穿着不同行走鞋底的铸鞋时以及穿着没有定制模制足部装置界面的新铸鞋时测量其足底压力。评估峰值压力、力-时间积分和行走舒适度。
与BTCC相比，TCC在拇趾、中足和（既往）溃疡部位的峰值压力分别低47%（P = 0.028）、26%（P = 0.003）和15%（P = 0.050）。与铸鞋相比，BTCC在前足区域和（既往）溃疡部位的峰值压力分别低39 - 43%和47%（均P < 0.001）。与铸鞋相比，TCC和BTCC的总力-时间积分分别低21%和1l%（P < 0.007）。TCC的行走舒适度评分为5.6，BTCC为6.5（P = 0.037）。其他设计特征（即行走鞋底和足底塑形）的影响不显著。
TCC具有更好的减压效果，主要是因为它是膝上型且不可拆卸的装置，提供了最佳的“轴效应”。然而，TCC对行走舒适度有负面影响。这些结果有助于在减轻糖尿病足底前足溃疡压力方面做出决策。
