Penny Harry, Tran Son, Sansosti Laura, Pettineo Steven, Bloom Andrew, Qureshi Rafay, Bickers David, Kreuz Emma, Zaki Peter, McGuire James
UPMC Altoona, 1414 9th Ave, Altoona, PA 16602.
Temple University, School of Podiatric Medicine 148 N. 8th Street, Philadelphia, PA 19107.
J Wound Care. 2020 Feb 1;29(Sup2c):S18-S26. doi: 10.12968/jowc.2020.29.Sup2c.S18.
The gold standard for offloading neuropathic forefoot and midfoot wounds is the total contact cast (TCC). However, in practice TCC is rarely used and is contraindicated in patients with fluctuating oedema, poor perfusion, lack of adequate tissue oxygenation and morbid obesity. It can also be too restrictive for patients, inevitably resulting in treatment rejection and delayed healing. This paper examines the role of shoe-based offloading devices as an alternative in reducing plantar pressure and optimising the healing of neuropathic ulcers.
Healthy subjects were recruited and fitted for two types of pixelated insoles: PegAssist (PA) insole system (Darco International, US) and FORS-15 (FORS) offloading insole (Saluber, Italy). An area of discreet, elevated high pressure was created by adding a 1/4-inch-thick felt pad to the plantar skin under the first metatarsal head. Subjects walked barefoot in surgical shoes with standard insoles (Condition 1), barefoot in pixelated insoles (Condition 2), barefoot with pixels removed (Condition 3). Dynamic plantar pressures were measured using F-Scan and the results were analysed to determine plantar pressure changes in each condition.
Using PA, the percentage reduction of plantar pressure (kPa) under the first metatarsal between Condition 1 and Condition 2 was 10.54±15.81% (p=0.022), between Condition 2 and Condition 3 was 40.13±11.11% (p<0.001), and between Condition 1 and Condition 3 was 46.67±12.95 % (p<0.001). Using FORS, the percentage reduction between Condition 1 and Condition 2 was 24.25±23.33% (p=0.0029), between Condition 2 and Condition 3 was 23.61±19.45% (p<0.001), and between Condition 1 and Condition 3 was 43.39±18.70% (p<0.001). A notable difference in the findings between the two insoles was the presence of a significant edge effect associated with PA, indicating that the offloading was not entirely successful. No edge effect was detected with FORS.
Our current analysis shows that pixelated insoles exhibit potential for supplemental offloading in surgical shoes. These devices could provide an alternative way for physicians to offload plantar wounds and expedite closure for patients that cannot tolerate a TCC or other restrictive devices.
卸载神经性前足和中足伤口的金标准是全接触石膏（TCC）。然而，在实际应用中，TCC很少被使用，并且对于水肿波动、灌注不良、组织氧合不足和病态肥胖的患者是禁忌的。它对患者来说也可能限制过大，不可避免地导致治疗被拒绝和愈合延迟。本文探讨了基于鞋子的卸载装置作为减少足底压力和优化神经性溃疡愈合的替代方法的作用。
招募健康受试者并为其配备两种像素化鞋垫：PegAssist（PA）鞋垫系统（美国Darco International公司）和FORS - 15（FORS）卸载鞋垫（意大利Saluber公司）。通过在第一跖骨头下方的足底皮肤添加一块1/4英寸厚的毡垫，创建一个离散的、压力升高的区域。受试者分别穿着带有标准鞋垫的手术鞋赤脚行走（条件1）、穿着像素化鞋垫赤脚行走（条件2）、去除像素后赤脚行走（条件3）。使用F - Scan测量动态足底压力，并对结果进行分析以确定每种条件下的足底压力变化。
使用PA时，条件1和条件2之间第一跖骨下方足底压力（kPa）的降低百分比为10.54±15.81%（p = 0.022），条件2和条件3之间为40.13±11.11%（p < 0.001），条件1和条件3之间为46.67±12.95%（p < 0.001）。使用FORS时，条件1和条件2之间的降低百分比为24.25±23.33%（p = 0.0029），条件2和条件3之间为23.61±19.45%（p < 0.001），条件1和条件3之间为43.39±18.70%（p < 0.001）。两种鞋垫的研究结果的一个显著差异是PA存在明显的边缘效应，这表明卸载并不完全成功。FORS未检测到边缘效应。
我们目前的分析表明，像素化鞋垫在手术鞋中具有辅助卸载的潜力。这些装置可以为医生提供一种替代方法来卸载足底伤口的压力，并为无法耐受TCC或其他限制性装置的患者加速伤口闭合。
