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Removable and Nonremovable Off-Loading Devices
Sarah L Carter1, Jasmine H M Law1, Nicole Seyler1
1*School of Allied Health, The University of Western Australia, Crawley, Australia.
Journal of the American Podiatric Medical Association
|June 26, 2025
Summary
Total-contact cast (TCC) is the gold standard for healing diabetic foot ulcers. While other devices show promise, TCC remains the most effective off-loading intervention for preventing amputations.
Area of Science:
- Podiatry
- Biomechanics
- Diabetic Foot Care
Background:
- Diabetic foot ulcers significantly increase amputation risk and mortality.
- Off-loading is a critical component of diabetic foot ulcer treatment.
- This study evaluated multiple off-loading devices for diabetic foot ulcers.
Purpose of the Study:
- To compare the effectiveness of different off-loading devices in reducing peak plantar pressure (PPP).
- To analyze PPP across nine specific regions of the plantar foot.
Main Methods:
- Utilized deidentified data from 12 healthy participants.
- Analyzed peak plantar pressure (PPP) in nine foot regions for various off-loading devices.
- Compared PPP data against control measurements.
Main Results:
- Removable controlled ankle motion walker, TCC, and R-TCC with brace significantly reduced PPP in most foot regions compared to controls.
- A nonsignificant increase in PPP was observed in the medial midfoot region for these devices.
- R-TCC with brace showed comparable PPP reduction to TCC in most regions.
Conclusions:
- Total-contact cast (TCC) remains the gold standard for diabetic foot ulcer off-loading.
- Findings expand on previous research by detailing regional PPP reduction.
- This study's results contradict some findings from prior research by Bhatt et al.
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