SLR - June 2017 - Ahmad T. Elhaouli
Reference: 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. 2016 Nov; 121: 166–172.
Reviewed By: Ahmad T. Elhaouli, DPM
Residency Program: Providence-Providence Park Hospital, Southfield, MI
Podiatric Relevance: Patients living with advanced states of diabetes can exhibit peripheral neuropathy, which puts those patients at increased risk for developing diabetic, or neurotropic, ulcerations on the feet. Podiatric physicians and surgeons are at a constant race with these ulcerations, trying to essentially heal them before they impose greater problems to the patients. Besides surgical treatment, conservative treatment consists of local wound care, and probably more importantly, offloading of the wounds. This article looks at the use of felt padding, which is commonly used by many podiatrists, and its effectiveness in preventing and/or helping to heal ulcerations by quantifying exactly how much pressure is offloaded by felt pads.
Methods: This prospective study looked at a total of 15 patients (16 neuropathic foot ulcers). Inclusion criteria were at least 18 years of age that had an active (nonhealed) plantar neuropathic foot ulcer. Exclusion criteria included PVD, inability to walk 10 meters without a walking aid, wounds that probed to bone or ulcerations with an active infection, based on the five cardinal signs of infection. Felt padding was applied in three different configurations. Measurements of peak plantar pressures, contact area and contact time were obtained using the pedarX insole placed in the all-purpose boots, with the original foam inserts removed. Data was collected using the ANOVA statistical model, specifically looking at baseline without padding, with newly applied felt padding and after seven days with worn felt padding.
Results: Peak pressures with newly applied felt padding and worn felt padding were significantly lower than peak pressures without any felt padding. New felt padding was found to decrease peak plantar pressure by 49 percent, while worn felt padding was found to reduce peak pressure by 32 percent. Also, contact area was found to be significantly higher with new and worn felt padding, compared to no felt padding. There were no significant differences in contact time across the conditions.
Discussion: New felt padding was shown to significantly reduce peak plantar pressure of an ulcer by as much as 49 percent compared to no felt padding, while worn felt padding was shown to decrease peak plantar pressure by only 32 percent, and this was a significant difference noted with above results. Limitations of this study were such that peak measures and contact area were not measured beyond the one-week time noted above. Also, this study was not a double-blinded study, and there was no randomization of the participants in this study. Although peak pressure was noted to be significantly lower with felt padding, future studies are needed to quantify the long-term effectiveness of felt padding for such wounds.