Advertisement

The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear

  • Anita Raspovic
    Correspondence
    Corresponding author at: Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Melbourne 3086, Australia.
    Affiliations
    Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne 3086, Australia
    Search for articles by this author
  • Kate Waller
    Affiliations
    Department of Podiatry and High Risk Foot Service, The Northern Hospital, 185 Cooper Street, Epping, Melbourne 3076, Australia
    Search for articles by this author
  • Wan Mun Wong
    Affiliations
    Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne 3086, Australia

    Podiatry Department, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore
    Search for articles by this author
Published:September 28, 2016DOI:https://doi.org/10.1016/j.diabres.2016.09.018

      Highlights

      • Limited data exists to support felt padding for offloading foot ulceration.
      • This study quantified pressure offloading under ulcers with new and worn felt.
      • Pressure under foot ulcers halved with new felt, reducing to one third with wear.
      • Increased contact area is a possible mechanism contributing to pressure reduction.
      • More studies are needed to evaluate the effectiveness of felt padding on healing.

      Abstract

      Aim

      Felt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear.

      Methods

      This study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear.

      Results

      Statistically significant decreases in peak pressure of 49% and 32% were measured with newly applied felt padding (188.0 kPa; p < 0.001) and worn felt padding (248 kPa; p = 0.003) respectively, compared to no padding (367.2 kPa). Worn felt offloaded 32% less pressure than new felt however this did not reach statistical significance (p = .069). Corresponding increases in contact area of 18% and 14% occurred with newly applied felt padding (156.9 cm2; p < .001) and worn felt padding (150.6 cm2; p = 0.003) compared to no padding (132.5 cm2). Contact time was constant across testing conditions.

      Conclusions

      New felt padding offloaded on average half the pressure applied to sites of plantar neuropathic ulceration, which reduced to one third after wear. Increased contact area under the foot is a possible mechanism contributing to pressure reduction. Further studies are required to evaluate effectiveness of felt padding directly on ulcer healing.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brownrigg J.R.
        • Davey J.
        • Holt P.J.
        • Davis W.A.
        • Thompson M.M.
        • Ray K.K.
        • Hinchliffe R.J.
        The association of ulceration of the foot with cardiovascular and all-cause mortaility in patients with diabetes: a meta-analysis.
        Diabetologia. 2012; 55: 2906-2912https://doi.org/10.1007/s00125-012-2673-3
        • Van Acker K.
        • Léger P.
        • Hartemann A.
        • Chawla A.
        • Siddiqui M.K.
        Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review.
        Diabetes/Metab Res Rev. 2014; 30: 635-645https://doi.org/10.1002/dmrr.2523
        • Guariguata L.
        • Whiting D.R.
        • Hambleton I.
        • Beagley J.
        • Linnenkamp U.
        • Shaw J.E.
        Global estimates of diabetes prevalence for 2013 and projections for 2035.
        Diabetes Res Clin Pract. 2014; 103: 137-149https://doi.org/10.1016/j.diabres.2013.11.002
        • Hunt D.
        Clinical evidence: diabetes, foot ulcers and amputations.
        Clinical evidence. 2009; 01: 602
        • Veves A.
        • Murray H.J.
        • Young M.J.
        • Boulton A.J.M.
        The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study.
        Diabetologia. 1992; 35: 660-663https://doi.org/10.1007/BF00400259
        • Pham H.
        • Armstrong D.G.
        • Harvey C.
        • Harkless L.B.
        • Giurini J.M.
        • Veves A.
        Screening techniques to identify people at risk for diabetic foot ulceration.
        Diabetes Care. 2000; 23: 606-611
        • Cavanagh P.R.
        • Bus S.A.
        Off-loading the diabetic foot for ulcer prevention and healing.
        J Vasc Surg. 2010; 52: 37S-43Shttps://doi.org/10.1016/j.jvs.2010.06.007
        • Waaijman R.
        • de Haart M.
        • Arts M.L.
        • Wever D.
        • Verlouw A.J.
        • Nollet F.
        • Bus S.A.
        Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients.
        Diabetes Care. 2014; 37: 1697-1705https://doi.org/10.2337/dc13-2470
        • Bus S.A.
        • van Deursen R.W.
        • Armstrong D.G.
        • Lewis J.E.A.
        • Caravaggi C.F.
        • Cavanagh P.R.
        • on behalf of the International Working Group on the Diabetic, F.
        Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.
        Diabetes/Metabol Res Rev. 2016; 32: 99-118https://doi.org/10.1002/dmrr.2702
        • Wu S.C.
        • Jensen J.L.
        • Weber A.K.
        • Robinson D.E.
        • Armstrong D.G.
        Use of pressure offloading devices in diabetic foot ulcers.
        Diabetes Care. 2008; 31: 2118-2119https://doi.org/10.2337/dc08-0771
        • Raspovic A.
        • Landorf K.B.
        A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers.
        J Foot Ankle Res. 2014; 7: 1-8https://doi.org/10.1186/s13047-014-0035-8
        • Armstrong D.G.
        • Liswood P.J.
        • Todd W.F.
        Potential risks of accommodative padding in the treatment of neuropathic ulcerations.
        Ostomy Wound Manage. 1995; 41 (pp. 48–49): 44-46
        • Deschamps K.
        • Messier B.
        Pressure reducing capacity of felt: a feasibility study using a new portable system with thin sensors.
        Diabetes Res Clin Pract. 2015; 107: e11-e14https://doi.org/10.1016/j.diabres.2015.01.007
        • Paton J.
        • Woodrow T.
        • Passmore C.
        The effect of plantar cover padding with U’d cut out on plantar foot pressure; a preliminary study.
        Br J Podiatry. 2007; 10: 110-115
        • Zimny S.
        • Reinsch B.
        • Schatz H.
        • Pfohl M.
        Effects of felted foam on plantar pressures in the treatment of neuropathic diabetic foot ulcers.
        Diabetes Care. 2001; 24: 2153
        • Birke J.A.
        • Pavich M.A.
        • Patout Jr., C.A.
        • Horswell R.
        Comparison of forefoot ulcer healing using alternative off-loading methods in patients with diabetes mellitus.
        Adv Skin Wound Care. 2002; 15 (210-210)
        • Nubé V.L.
        • Molyneaux L.
        • Bolton T.
        • Clingan T.
        • Palmer E.
        • Yue D.K.
        The use of felt deflective padding in the management of plantar hallux and forefoot ulcers in patients with diabetes.
        Foot (Edinburgh, Scotland). 2006; 16: 38-43https://doi.org/10.1016/j.foot.2005.11.005
        • Curran Ratcliffe.
        • Campbell
        A comparison of types and thicknesses of adhesive felt padding in the reduction of peak plantar pressure of the foot: a case study.
        J Med Case Rep. 2015; 9: 203https://doi.org/10.1186/s13256-015-0675-8
        • Raspovic A.
        • Landorf K.B.
        • Gazarek J.
        • Stark M.
        Reduction of peak plantar pressure in people with diabetes-related peripheral neuropathy: an evaluation of the DH pressure relief shoe (TM).
        J Foot Ankle Res. 2012; 5: 25https://doi.org/10.1186/1757-1146-5-25
        • Schaper N.C.
        Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies.
        Diabetes/Metabol Res Rev. 2004; 20: S90-S95https://doi.org/10.1002/dmrr.464
        • Lipsky B.A.
        • Berendt A.R.
        • Cornia P.B.
        • Pile J.C.
        • Peters E.J.G.
        • Armstrong D.G.
        • Senneville E.
        2012 Infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections.
        Clin Infect Dis. 2012; 54: e132-e173https://doi.org/10.1093/cid/cis346
        • Bus S.A.
        Innovations in plantar pressure and foot temperature measurements in diabetes.
        Diabetes/Metabol Res Rev. 2016; 32: 221-226https://doi.org/10.1002/dmrr
        • Godi M.
        • Turcato A.M.
        • Schieppati M.
        • Nardone A.
        Test-retest reliability of an insole plantar pressure system to assess gait along linear and curved trajectories.
        J NeuroEng Rehabil. 2014; 11: 1-8https://doi.org/10.1186/1743-0003-11-95
        • Stess R.M.
        • Jensen S.R.
        • Mirmiran R.
        The role of dynamic plantar pressures in diabetic foot ulcers.
        Diabetes Care. 1997; 20: 855-858
        • Cavanagh P.R.
        • Bus S.A.
        Off-loading the diabetic foot for ulcer prevention and healing.
        J Am Podiatr Med Assoc. 2010; 100: 360-368https://doi.org/10.7547/1000360