title: The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear.
abstract: OBJECTIVE
  Felt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear.
  
  
  METHODS
  This study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear.
  
  
  RESULTS
  Statistically significant decreases in peak pressure of 49% and 32% were measured with newly applied felt padding (188.0kPa; p<0.001) and worn felt padding (248kPa; p=0.003) respectively, compared to no padding (367.2kPa). Worn felt offloaded 32% less pressure than new felt however this did not reach statistical significance (p=.069). Corresponding increases in contact area of 18% and 14% occurred with newly applied felt padding (156.9cm2; p<.001) and worn felt padding (150.6cm2; p=0.003) compared to no padding (132.5cm2). Contact time was constant across testing conditions.
  
  
  CONCLUSIONS
  New felt padding offloaded on average half the pressure applied to sites of plantar neuropathic ulceration, which reduced to one third after wear. Increased contact area under the foot is a possible mechanism contributing to pressure reduction. Further studies are required to evaluate effectiveness of felt padding directly on ulcer healing.
authors.affiliation: Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne 3086, Australia. Electronic address: a.raspovic@latrobe.edu.au.
authors.forename: Anita
authors.initials: A
authors.lastname: Raspovic
authors.affiliation: Department of Podiatry and High Risk Foot Service, The Northern Hospital, 185 Cooper Street, Epping, Melbourne 3076, Australia. Electronic address: Kate.Waller@nh.org.au.
authors.forename: Kate
authors.initials: K
authors.lastname: Waller
authors.affiliation: Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne 3086, Australia; Podiatry Department, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore. Electronic address: wong.wan.mun@alexandrahealth.com.sg.
authors.forename: Wan Mun
authors.initials: WM
authors.lastname: Wong
mesh_terms: D017719:Diabetic Foot / Q000503:physiopathology / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011482:Protective Devices; D012775:Shoes; D013997:Time Factors; D014945:Wound Healing
keywords: Diabetes; Felt padding; Foot ulcer; Offloading; Pressure