A new orthosis for pressure reduction in a chronic heel ulcer

O. Bézard, C. Roth, P. Nussbaumer

Objective

Elevated plantar pressure is a causative factor in the development of most plantar pressure ulcers in diabetic and non diabetic patients. Therefore plantar pressure reduction by off loading is one of the key factors for a successful treatment. This can be achieved by various means such as non removable devices like casts, conventional footwear or customized foot orthotic therapy. Depending on the aetiology of the heel ulcer the mean healing time takes as long as 4 months. We present the case of a patient with a chronic heel ulcer where a new type of orthotic therapy led to rapid healing.

Results

We present a 72 year old female patient suffering from a chronic plantar heel ulcer of a mechanical ethnology for almost a year prior to being admitted to our wound clinic. She did not have any significant co morbidity, above all no diabetes or peripheral arterial occlusive disease. The one complicating factor was a contra lateral foot drop due to a palsy of the peroneal nerve. The ulcer was 2 cm in diameter, showed no signs of infection and concomitant osteomyelitis were excluded by X-ray exam. Local therapy comprised of alginate dressings. Initial therapy with a cast and partial weight bearing did not promote significant wound healing and restricted the patient severely in her ambulation. In collaboration with our orthopaedic technician we designed a new type of orthotic including a socket involving the distal femur. Pressure reduction was achieved despite full weight bearing. Complete wound healing was accomplished within 40 days. Manufacturing cost was 2500.- SFr., corresponding to 62.- SFr. per day.

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Conclusion

Pressure reduction by off loading is one of the key factors for a successful treatment of heel ulcers. With this newly designed orthotic including a socket involving the distal femur we achieved rapid wound healing. Compared to standard methods the new device seems cost effective. Normal ambulation was possible despite the contra lateral neurological disorder.