Modified offloading approach for foot ulcers improves comfort, could increase adherence
medwireNews: Researchers report that use of an ankle-high removable cast walker (RCW), paired with an external lift on the other shoe, improves patients’ comfort and could therefore lead to better adherence, resulting in improved healing of diabetic foot ulcers.
As reported in Diabetes Care, patients at risk for foot ulcers rated the ankle-high RCW as significantly more comfortable than a standard knee-high one, and comfort further improved, and gait variability decreased, if they had an external lift on the contralateral shoe to prevent uneven limb lengths.
However, Ryan Crews and Joseph Candela, from Rosalind Franklin University in Chicago, Illinois, USA, found that increased comfort came at the cost of reduced offloading efficacy, with the reductions in peak pressure slightly but significantly smaller with the ankle- versus knee-high RCW and with versus without a contralateral lift.
Nonetheless the team says: “If the improved comfort and stability associated with the ankle-high RCW paired with a contralateral lift lead to higher RCW adherence, it is conceivable that the higher adherence would more than make up for any detriments to wound healing associated with the slightly smaller amplitude in offloading capacity.”
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