Howard IM: The prevention of foot ulceration in diabetic patients. Phys Med Rehabil Clin N Am 20: 595, 2009.
Gallego Estévez R, Camp Faulí A, Viel i Blasco C, et al: Alternativas para la descarga de la úlcera neuropática en el pie diabético. Av En Diabetol 26: 457, 2010.
Boulton AJ: Pressure and the diabetic foot: clinical science and offloading techniques. Am J Surg 187: 17S, 2004.
Cavanagh PR, Bus SA: Off-loading the diabetic foot for ulcer prevention and healing. JAPMA 100: 360, 2010.
Bus SA: The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence. Plast Reconstr Surg 138: 179S, 2016.
Armstrong DG, Lavery LA, Wu S, et al: Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 28: 551, 2005.
Cameron-Fiddes V, Santos D: The use of “off-the-shelf” foot orthoses in the reduction of foot symptoms in patients with early rheumatoid arthritis. Foot (Edinb) 23: 123, 2013.
Raspovic A, Landorf K, Gazarek J, et al: Reduction of peak plantar pressure in people with peripheral neuropathy: an evaluation of the DH Pressure- Relief ShoeTM. J Foot Ankle Res 5: 25, 2012.
Raspovic A, Waller K, Wong WM: The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear. Diabetes Res Clin Pract 121: 166, 2016.
Zimny S, Schatz H, Pfohl U: The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers. Diabet Med 20: 622, 2003.
Fleischli JG, Lavery LA, Vela SA, et al: Comparison of strategies for reducing pressure at the site of neuropathic ulcers. JAPMA 87: 466, 1997.
Raspovic A, Landorf KB: A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers. J. Foot Ankle Res 7: 35, 2014.
Halstead J, Redmond AC: Weight-bearing passive dorsiflexion of the hallux in standing is not related to hallux dorsiflexion during walking. J Orthop Sports Phys Ther 36: 550, 2006.
Curran MJ, Ratcliffe C, Campbell J: A comparison of types and thicknesses of adhesive felt padding in the reduction of peak plantar pressure of the foot: a case report. J Med Case Rep 9: 203, 2015.
Tong JW, Ng EY: Preliminary investigation on the reduction of plantar loading pressure with different insole materials (SRP–Slow Recovery Poron, P–Poron, PPF–Poron+Plastazote, firm and PPS–Poron+Plastazote, soft). Foot (Edinb) 20: 1, 2010.
Armstrong DG, Liswood PJ, Todd WF: Potential risks of accommodative padding in the treatment of neuropathic ulcerations. Ostomy Wound Manage 41: 44, 1995.
Curran MJ, Ratcliffe C, Campbell J: A comparison of types and thicknesses of adhesive felt padding in the reduction of peak plantar pressure of the foot: a case report. J Med Case Rep 9: 203, 2015.
Gatt A, Briffa A, Chockalingam N, et al: The applicability of plantar padding in reducing peak plantar pressure in the forefeet of healthy adults: implications for the foot at risk. JAPMA 106: 246, 2016.
The aim of this study was to observe the pressure changes in the felt padding used to off-load pressure from the first metatarsal head, the effects obtained by different designs, and the loss of effectiveness over time.
With a study population of 17 persons, two types of 5-mm semicompressed felt padding were tested: one was C-shaped, with an aperture cutout at the first metatarsophalangeal joint, and the other was U-shaped. Pressures on the sole of the foot were evaluated with a platform pressure measurement system at three time points: before fitting the felt padding, immediately afterward, and 3 days later.
In terms of decreased mean pressure on the first metatarsal, significant differences were obtained in all of the participants (P < .001). For plantar pressures on the central metatarsals, the differences between all states and time points were significant for the C-shaped padding in both feet (P < .001), but with the U-shaped padding the only significant differences were between no padding and padding and at day 3 (P = .01 and P = .02).
In healthy individuals, the U-shaped design, with a padding thickness of 5 mm, achieved a more effective and longer-lasting reduction in plantar pressure than the C-shaped design.