Influence of Offloading Devices’ Size and Induced Limb Length Discrepancy upon Gait and Perceived Comfort of Individuals at Risk of Diabetic Foot Ulceration

INTRODUCTION Offloading devices help heal diabetic foot ulcers by taking mechanical pressure off the injured foot during weight bearing activities [1]. While offloading devices are an effective treatment measure, their designs give little consideration to the gait alterations or postural instability they induce [1, 2]. Although less frequently used than removable cast walkers (RCW), non-removable cast walkers have been shown to be a better treatment option for diabetic foot ulcers simply because compliance is increased with the non-removable cast walkers. One likely reason for poor compliance with RCW is the decreased postural stability associated with offloading devices [1, 2]. Some of this instability may be attributed to induced limb length discrepancies (LLD), which are a common problem with offloading walkers. In addition to causing gait and balance difficulties, LLD cause several musculoskeletal problems such as joint pain [1, 3-6]. The large size and weight of most RCW also likely impede compliance. The purpose of this study was to evaluate how 1) using an elevating device (lift) on the contralateral foot and 2) modifying RCW size, will impact detrimental changes in gait and comfort associated with RCW use.