The Effect of Plantar Cover Padding with Ud Cut Out on Plantar Foot Pressure

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The Effect of Plantar Cover Padding with Ud Cut
Out on Plantar Foot Pressure

• Joanne Paton MSc BSc
• Musculoskeletal Specialist Podiatrist
• North and East Cornwall PCT
• Other author Tania Woodrow
• Specialist Diabetes Podiatrist
• Central Cornwall PCT

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Background

• 15 of diabetic individuals are expected to
  develop a foot ulcer sometime in there lifetime.
  Spencer 2004
• The are 15060 registered diabetics residing in
  Cornwall.
• 14-24 of all diabetic related foot ulcers result
  in amputation. Reiber 1998
• Approximately 200 leg, foot and toe amputations
  were carried out at RCHT and Plymouth Hospitals
  Trust on Cornish residents in a recent 18-month
  period.
• (Jan 2002-April 2003)

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Biomechanical Factors in the etiology of
neuropathic foot ulceration
Adapted from Cavanagh 1995
Elevated plantar pressure
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Management and Prevention

• Peak Pressures are a strong contributing factor
  in the the development and healing of neuropathic
  ulcers
  
• Armstrong et al 1997
• Boulton et al 1983

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Aim

• To determine the effect of a 7mm semi-compressed
  felt plantar cover pad (with Ud cut out) on
  forefoot pressure and forefoot pressure time
  integral
• Within the confines of the U
• At the periphery of the U

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Plantar Pressure and Pressure Time Integrals
0.000 Seconds
0.602 Seconds
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Methodology

• 10 healthy subjects, 20 feet
• Male Female 28
• Mean age of 31.37 years (Range 19-53)
• Required to wear lace-up flat shoes
• Wax plaster lesion located at 2nd
  metatarsophalangeal joint
• 7mm SCF plantar cover
• U 20mm diameter

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Data Collection

• F-Scan in-shoe pressure measurement system
• Preconditioning and calibration
• Constant walking velocity maintained
• 4-5 consecutive steps per trial recorded
• 2 trials recorded
• No padding with simulated lesion
• With 7 mm SCF plantar cover with U

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Results Change in Pressure at the Centre of the
U
Change
Sample
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Results Change in Pressure at the Periphery of
the U
Change
Sample
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Data Analysis

• Simple demographics were computed and related
  sample t-tests performed using SPSS v.11.5
• The peak pressure and pressure time integral at
  the centre of the U decreased by a mean of 25
  and 29 respectively (plt0.001).
• The PP and PTI at the periphery of the U
  increased by a mean of 44 and 57 respectively
  (plt0.001).

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Relevance to Clinician

• Pressure time integral can be considered as an
  appropriate measurement tool to assess the
  effectiveness of accommodative adhesive padding.

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Relevance to Clinician

• Whilst the effect at the centre of the U is to
  reduce the mechanical stress to the area the
  effect at the periphery is to substantially
  increase it.
• This increase could be potentially detrimental to
  the patient, possibly inhibiting the healing
  process by
• creating an area of ischemia
• increasing the effects of shear

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Conclusion

• The findings of this study suggest that
  additional investigations are needed to determine
  whether clinical outcomes are influenced by the
  use of Ud padding

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Thank-you
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References

• Armstrong DG, Lavery LA, Bushman TR. (1997) Peak
  foot pressures influence the healing time of
  diabetic foot ulcers treated with total contact
  cast. Journal of rehabilitation research and
  development.
• Boulton AJ, Hardisty CA, Betts RP et al. (1983)
  Dynamic foot pressure and other studies as
  diagnostic and management aid in diabetic
  neuropathy.Diabetes care 6 26.
• V Cavanagh PR. Ulbrecht JS, Caputo GM. (1996)
  Biomechanical aspects of diabetic foot disease
  aetiology, treatment and prevention. Diabetic
  medicine. 13 S17-S22.
• V Spencer, S. (2004). "Pressure relieving
  interventions for preventing and treating
  diabetic foot ulcers (Cochrane review)." The
  Cochrane Library(3).