Abstract
Background: Reducing weight-bearing stress to diabetic foot ulcers is critical to healing and commonly called offloading. Removable cast walkers are frequently used for offloading; however, patient compliance is often poor. Walkers commonly extend to the knee. Patients complain about walkers' weight and diminished balance with their use. This study compared the offloading capacity of walkers that varied by height. Heights included: knee, ankle, and shoe levels. To ensure a fair comparison the outsole and insole were standardized across the devices. Methods: Eleven diabetic subjects with moderate to high risk of ulceration were recruited. Subjects completed four 20 m walking trials. Subjects performed one trial with each walker and one trial with an athletic shoe. Primary outcomes focused on plantar loading and were measured by pressure insoles. Secondary outcomes were associated with gait kinematics as collected by body worn sensors. Findings: Significant differences were found for the peak pressure and pressure time integrals of the different footwear. All walkers performed better than the athletic shoe. The ankle and knee-high devices performed best. Center of mass rotation data showed a trend of the ankle walker yielding a smaller range of motion (18% medial/lateral and 22% anterior/posterior) than the knee level. Interpretation: The ankle-high walker was able to provide similar offloading capacities as the knee-high walker. The diminished weight, along with potentially improved stability, may result in improved compliance with ankle-high walkers. A study comparing the use of the two devices for treating ulcers is now suggested.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 725-730 |
| Number of pages | 6 |
| Journal | Clinical Biomechanics |
| Volume | 27 |
| Issue number | 7 |
| DOIs | |
| State | Published - Aug 2012 |
| Externally published | Yes |
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Keywords
- Diabetes
- Diabetic foot ulcer
- Offloading
- Pedobarography
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Biophysics
Cite this
Impact of strut height on offloading capacity of removable cast walkers. / Crews, Ryan T.; Sayeed, Fraaz; Najafi, Bijan.
In: Clinical Biomechanics, Vol. 27, No. 7, 08.2012, p. 725-730.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of strut height on offloading capacity of removable cast walkers
AU - Crews, Ryan T.
AU - Sayeed, Fraaz
AU - Najafi, Bijan
PY - 2012/8
Y1 - 2012/8
N2 - Background: Reducing weight-bearing stress to diabetic foot ulcers is critical to healing and commonly called offloading. Removable cast walkers are frequently used for offloading; however, patient compliance is often poor. Walkers commonly extend to the knee. Patients complain about walkers' weight and diminished balance with their use. This study compared the offloading capacity of walkers that varied by height. Heights included: knee, ankle, and shoe levels. To ensure a fair comparison the outsole and insole were standardized across the devices. Methods: Eleven diabetic subjects with moderate to high risk of ulceration were recruited. Subjects completed four 20 m walking trials. Subjects performed one trial with each walker and one trial with an athletic shoe. Primary outcomes focused on plantar loading and were measured by pressure insoles. Secondary outcomes were associated with gait kinematics as collected by body worn sensors. Findings: Significant differences were found for the peak pressure and pressure time integrals of the different footwear. All walkers performed better than the athletic shoe. The ankle and knee-high devices performed best. Center of mass rotation data showed a trend of the ankle walker yielding a smaller range of motion (18% medial/lateral and 22% anterior/posterior) than the knee level. Interpretation: The ankle-high walker was able to provide similar offloading capacities as the knee-high walker. The diminished weight, along with potentially improved stability, may result in improved compliance with ankle-high walkers. A study comparing the use of the two devices for treating ulcers is now suggested.
AB - Background: Reducing weight-bearing stress to diabetic foot ulcers is critical to healing and commonly called offloading. Removable cast walkers are frequently used for offloading; however, patient compliance is often poor. Walkers commonly extend to the knee. Patients complain about walkers' weight and diminished balance with their use. This study compared the offloading capacity of walkers that varied by height. Heights included: knee, ankle, and shoe levels. To ensure a fair comparison the outsole and insole were standardized across the devices. Methods: Eleven diabetic subjects with moderate to high risk of ulceration were recruited. Subjects completed four 20 m walking trials. Subjects performed one trial with each walker and one trial with an athletic shoe. Primary outcomes focused on plantar loading and were measured by pressure insoles. Secondary outcomes were associated with gait kinematics as collected by body worn sensors. Findings: Significant differences were found for the peak pressure and pressure time integrals of the different footwear. All walkers performed better than the athletic shoe. The ankle and knee-high devices performed best. Center of mass rotation data showed a trend of the ankle walker yielding a smaller range of motion (18% medial/lateral and 22% anterior/posterior) than the knee level. Interpretation: The ankle-high walker was able to provide similar offloading capacities as the knee-high walker. The diminished weight, along with potentially improved stability, may result in improved compliance with ankle-high walkers. A study comparing the use of the two devices for treating ulcers is now suggested.
KW - Diabetes
KW - Diabetic foot ulcer
KW - Offloading
KW - Pedobarography
UR - http://www.scopus.com/inward/record.url?scp=84863630846&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84863630846&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiomech.2012.03.001
DO - 10.1016/j.clinbiomech.2012.03.001
M3 - Article
C2 - 22465241
AN - SCOPUS:84863630846
VL - 27
SP - 725
EP - 730
JO - Clinical Biomechanics
JF - Clinical Biomechanics
SN - 0268-0033
IS - 7
ER -