Journal of Medicine Vol 2 - Amrita Institute of Medical Sciences and ...

Amrita Journal of Medicine
Adhesive Felt Offloading in the Healing of Diabetic Foot Ulcers
foot is in contact the last 59 percent of the phase. This
means all of the body weight is on one heel or one forefoot
a significant period of time. This pressure can equal
1.2 to 1.5 times the body weight depending on the walking
speed 5 .
When a deformity is present, there is increased pressure
on the foot. Researchers have shown that diabetes
causes a decrease in conduction speed in the tibial and
peroneal nerves. This correlates to increased lower extremity
muscle weakness. Muscle weakness may lead to
foot deformity and subsequently cause areas of increased
pressure 6 .
With regard to offloading; some material is usually
placed on the foot such as padding or dressings. However,
the first and most important offloading technique
is to actually take pressure off from the skin of the plantar
aspect of the foot. Debriding the hyperkeratotic skin
surrounding the wound edge is the one aspect of
offloading that one should address 7,8 . When left untreated,
the thick and callused edges of a wound will roll
inward and inhibit the wound edges from migrating towards
the center. This hyperkeratotic edge may also cause
increased plantar pressure. Based upon Dr. Paul Brand’s
work that demonstrated the greatest amount of pressure
placed on a foot ulcer is at the leading edge, Armstrong
and Athanasiou later coined the term “edge effect” 13,16 .
One might think the greatest pressure would be in the
center of the wound but many plantar ulcers have such
significant depth that the weight bearing forces do not
affect the center of the wound. Due to the natural
offloading of the central wound cavity, plantar foot pressures
intensify at the leading edge of the wound. This is
why many plantar foot ulcers need weekly, or at least
frequent, debridement for offloading purposes 9,15 .
Gait modification offers another simple means of
offloading the foot. A reduction in walking speed or shuffling-type
gait can reduce the pressure on the forefoot.
Unfortunately, it is sometimes difficult for patients to
change their walking patterns abruptly. Physical medicine
can be helpful in retraining patients in gait when
needed. All attempts should be made to keep these patients
ambulatory with the exception of large wounds.
Continued ambulation can reduce other morbidity. Medical
grade adhesive felt is an excellent technique for
ambulatory offloading of plantar ulcers in diabetic patients
10, 11 .
Felts are a class of fabrics or fibrous structures obtained
through the interlocking of wool, fur, cotton, rayon
or some hair fibers under conditions of heat, moisture,
and pressure. With the exception of felt, nonwoven
materials are in the early stages of development. Nonwoven
fabrics can be defined as textile fabrics made of a
Plate: 1
A
B
C
D
A: Shows a forefoot plantar ulcer prior to starting felt offloading treatment. B: Shows felt pad applied around the
ulcer. C: Shows healing ulcer after about 3 weeks of treatment. D: Shows epithelialised ulcer.
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