Offloading Plantar Pressures in Healthy Adults: Stirrup Cast vs Total Contact Cast

Area of Science:

• Orthopedics
• Biomechanics
• Diabetic Foot Care

Background:

• Diabetic foot ulcers present significant morbidity and mortality challenges.
• Offloading is a primary treatment strategy for diabetic foot ulcers.
• Total contact casting (TCC) is common but has limitations in hindfoot offloading.

Purpose of the Study:

• To compare the foot offloading effectiveness of TCC versus a stirrup cast.
• To evaluate the biomechanical differences in offloading between TCC and stirrup casts.

Main Methods:

• A pilot observational study involved 12 healthy volunteers.
• Foot loading parameters (force, pressure, contact time/area) were measured using a Pedar sensor inside TCC and stirrup casts.

Main Results:

• The stirrup cast demonstrated significantly greater reductions in plantar foot loading parameters compared to TCC.
• Reductions of 85%-96% in forefoot maximum force and peak pressure were observed with the stirrup cast (P < .0001).
• Significant reductions in other loading parameters across foot regions were also noted (P < .05).

Conclusions:

• The stirrup cast is more effective than TCC in offloading the foot, particularly the forefoot and midfoot.
• This suggests potential benefits of stirrup casts for managing diabetic foot ulcers, especially those involving the hindfoot.