Total contact casts and removable cast walkers. Mitigation of plantar heel pressure

The purpose of this study was to compare the ability of various modalities to reduce pressure in the plantar heel. Twenty-five patients with grade 1A plantar foot ulcerations were evaluated; a repeat measures design comparing plantar pressure was used to evaluate the total contact cast, the Aircast pneumatic walker, the DH pressure relief walker, and depth-inlay shoes. The total contact cast reduced pressure significantly better than the other modalities; however, its pressure reduction was only 33% less than a baseline sneaker. All other modalities reduced significantly more pressure than the depth-inlay shoe. The DH walker had a significantly lower pressure-time integral than other modalities. These data indicate that, while the total contact cast appears to be effective compared with other modalities, the role that limitation of transverse motion of the fat pad on compression at heel strike has yet to be fully explained.