Offloading Plantar Pressures in Healthy Adults: Stirrup Cast vs Total Contact Cast

Abstract

Background: Diabetic foot ulcers are associated with significant morbidity and mortality while posing a challenge for healthcare professionals. Offloading is considered the mainstay of treatment. Total contact casting (TCC) is widely used but does not effectively offload the hindfoot. Some studies suggest that a metal stirrup is effective at offloading midfoot and hindfoot ulcers. The primary purpose of this study is to compare the offloading mechanism of TCC to a stirrup cast. Methods: A pilot observational study assessing 12 healthy volunteers who underwent casting with a TCC or stirrup cast. A sensor (Pedar; Novel GmbH) that measures maximum force, peak pressure, and contact time and area of each foot region, was placed inside the cast to assess the offloading mechanisms of the 2 interventions. Results: We measured a reduction in all plantar foot loading parameters from the TCC to the stirrup cast. The highest reductions of 85% to 96% (±5%-13%) were noted in maximum force and peak pressure under the forefoot ( P < .0001) and found reductions in maximum force, the contact area of all regions of the foot, peak pressure and contact time of the forefoot and midfoot, and contact area of the hindfoot ( P < .05). Conclusion: In this experimental trial of healthy adults, the stirrup cast was more effective than the TCC by offloading the foot mostly in the forefoot and midfoot.