Potential risks of accommodative padding in the treatment of neuropathic ulcerations

In order to appropriately treat the pedal diabetic wound, the treatment plan must have as its central focus the elimination or reduction of foci of stress. The purpose of this study is to analyze the off-weighting ability of aperture pads in an effort to help the practitioner choose an appropriate and effective stress relieving modality. Patients were fitted and measured while ambulating using 3 different accommodative modalities. Utilizing an electronic measurement system for the recording of pressure distribution, the plantar pressure of each subject was recorded. Measurements taken during accommodative padding were compared with the same foot or corresponding site during unpadded ambulation. The data indicates that when apertures are created in an attempt to off-weight a given ulceration or area of stress, an area of increased vertical pressure is created at the periphery of the ulceration; and that while the central aspect of the aperture pad seems to off-weight the area, the periphery bears an undue amount of vertical stress, thus amplifying shear forces and tearing of tissue as the metatarsal moves proximally during gait. We therefore conclude that none of the devices reviewed are ideal for off-weighting the plantar neurotrophic wound.