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Plantar Pressure Changes Using a Novel Negative Pressure Wound Therapy Technique

David G. Armstrong, DPM, MSc ^* , Kristin Kunze ^*, Billy R. Martin, DPM ^*, Heather R. Kimbriel, BS ^*, Brent P. Nixon, DPM ^* and Andrew J. M. Boulton, MD 

^* Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson.
Department of Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.
Diabetes Research Institute, University of Miami, Miami, FL; Department of Medicine, Manchester Royal Infirmary, Manchester, England.

Corresponding author: David G. Armstrong, DPM, MSc, Department of Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064.

Abstract

This study evaluated changes in pressure imparted to diabetic foot wounds using a novel negative pressure bridging technique coupled with a robust removable cast walker. Ten patients had plantar pressures assessed with and without a bridged negative pressure dressing on the foot. Off-loading was accomplished with a pressure-relief walker. Plantar pressures were recorded using two pressure-measurement systems. The location and value of peak focal pressure (taken from six midgait steps) were recorded at the site of ulceration. Paired analysis revealed a large difference (mean ± SD, 74.6% ± 6.0%) between baseline barefoot pressure and pressure within the pressure-relief walker (mean ± SD, 939.1 ± 195.1 versus 235.7 ± 66.1 kPa). There was a mean ± SD 9.9% ± 5.6% higher pressure in the combination device compared with the pressure-relief walker alone (mean ± SD, 258.0 ± 69.7 versus 235.7 ± 66.1 kPa). This difference was only 2% of the initial barefoot pressure imparted to the wound. A modified negative pressure dressing coupled with a robust removable cast walker may not impart undue additional stress to the plantar aspect of the foot and may allow patients to retain some degree of freedom (and a potentially reduced length of hospital stay) while still allowing for the beneficial effects of negative pressure wound therapy and sufficient off-loading. (J Am Podiatr Med Assoc 94(5): 456–460, 2004)