The use of felt deflective padding in the management of plantar hallux and forefoot ulcers in patients with diabetes

Abstract

Background Foot ulceration in diabetes is precipitated and perpetuated by many factors, chiefly peripheral neuropathy and biomechanical abnormalities. Offloading of plantar pressure is a key element in the management of diabetic neuropathic foot ulcers with different techniques available to achieve this. Felt deflective padding (or accommodative padding) with an aperture over the ulcer site has been shown to reduce pressure. Objectives To determine whether the application of felt deflective padding (FDP) to the skin is more effective in healing ulcers than using the same padding within the shoe and secondly, whether similar rates of closure are achievable for hallux ulcers and forefoot ulcers treated with FDP. Method Patients presenting with plantar neuropathic ulcers of the forefoot or hallux were randomised to receive FDP applied to their skin or footwear. The rate of wound closure was determined from calculation of wound area obtained by counting over a grid. Data were analysed with respect to the type of padding used and the site of the ulcer. Results Thirty-two patients continued for 4 weeks or until healing. Patient's ages, duration of diabetes, ulcer size and neuropathy status were similar between the skin and shoe groups. Similar rates of wound closure were achieved when the padding was applied to the skin and the shoe ( z = 0.02, p = 0.9) and when the hallux ulcers and forefoot ulcers were compared ( z = 0.04, p = 0.9). Conclusions Felt deflective padding can be used with similar outcomes on small, primarily neuropathic ulcers on the hallux or forefoot with both skin or shoe applications providing similar rates of wound closure.