title: Impact of strut height on offloading capacity of removable cast walkers.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, Chicago, IL 60064, USA. Ryan.Crews@rosalindfranklin.edu
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Crews
authors.forename: Fraaz
authors.initials: F
authors.lastname: Sayeed
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
mesh_terms: D002370:Casts, Surgical; D017719:Diabetic Foot / Q000503:physiopathology* / Q000534:rehabilitation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D013314:Stress, Mechanical; D014853:Walkers; D016138:Walking; D016474:Weight-Bearing