Diabetic foot ulcers (DFUs) are a complication of diabetes, reducing patients’ quality of life, increasing morbidities, and contributing to more the $30B annually in increased for the U.S. healthcare system. Total Contact Cast (TCC) is considered the gold standard for healing DFUs. Within the last decade a number of prefabricated TCC kits such as TCC-EZ have been introduced, which offer a user-friendly casting process for healthcare providers. However, these casts and their associated boots or shoes cause asymmetry in gait. They may also result in reduction of weight bearing on the casted side and eventually affect the healing of DFUs. The purpose of this exploratory study was to determine the effectiveness of a shoe balancer called Evenup in redistribution of plantar peak pressure (PP) during gait. Sixteen subjects provided informed consent, 5 of whom had diabetic neuropathy (one Type I, four Type II), and completed three trials of 30-m walking while fitted with TCC-EZ and TCC, either with or without Evenup, in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance, and pedobarographic insoles (Novel, Germany) measured and recorded plantar pressures. For each trial, the mid-gait six steps for each side were analyzed. Paired t-tests were used to compare bilateral PP difference, as well as whether presence of Evenup changed differences in pressure side to side. Bilateral PP difference in TCC (p=0.166) and TCC-EZ (p=0.123) arms did not reveal significance due to presence of Evenup (p>0.05) while both modalities showed significant PP reduction side to side (p≤0.001). More research is necessary to reveal the potential clinical benefits of the use of shoe lifts in diabetic foot offloading, falls in diabetic patients and healing rates in a larger cohort.
A. Ersen: None. D. Jupiter: None. K.M. Raspovic: Consultant; Self; Orthofix. L.A. Lavery: Advisory Panel; Self; Acelity, Bayer AG. Consultant; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Smith & Nephew. M. Yavuz: Research Support; Self; Integra LifeSciences. Other Relationship; Self; Vivonics Inc.