Can A Novel Felt Pad Help Offload Plantar Ulcers?

On my recent journey to the Society for Chiropodists and Podiatrists 100th Anniversary Conference and Exhibition in Glasgow, Scotland, I saw the exhibit hall display for Hapla (Cuxson Gerrard) felt. My U.K. mentor, Dr M. Tariq Khan, PhD, uses this in his podiatric clinic. When I spent time training with Dr. Khan years ago, he introduced me to the Hapla 3D system. This system is a combination of Hapla felt and Chirofix (a soft fabric strapping similar to Omnifix) that one applies to the plantar aspect of the foot not only to offload a plantar ulcer, but also to gain accessibility to the ulcer for dressing changes.

We all know offloading plantar diabetic foot ulcers can be a challenge. Treating these plantar wounds involves both short-term and long-term placement and control of the dressing as well as patient adherence. The implementation of this 3D felt padding system in Temple’s Wound Care Center showed assistance in achieving adherence and ultimately a decrease in wound size.

The 3D felt padding system is a novel offloading system that allows the patient to have access to an aperture for wound dressing changes while still maintaining pressure redistribution. The instructions on how to apply the padding system are available on this Web site or on a DVD directly from Hapla (http://www.ninjastudio.co.uk/awdsite/examples.html and http://www.hapla.co.uk/hapla-commitment-to-training ). If you have felt, tape, and a willing patient, this technique is easy to reproduce.

Lesly Robinson, DPM, and I applied this system to several patients for their plantar wounds and then had them ambulate in a surgical shoe.1 We applied a topical wound product (Altrazeal powder, Uluru) in the office, taught patients how to take care of the dressing at home, and followed them weekly, ranging from four visits to 12 visits.

In less than four weeks, one of the patient’s ulcers decreased in size by 1.4 cm in length and 0.3 cm in width. Moreover, after one week of treating the ulcer with Altrazeal, the ulcer base became 100 percent granular. Another patient’s plantar heel ulcer resolved in 11 weekly visits using the aforementioned protocol.

The combination of the wound dressing and offloading felt padding system provided a painless, efficient and protective wound treatment that not only assisted in wound closure, but also in wound preparation for further interventions. Perhaps you have a patient in your wound care center who is tolerant of adhesive-backed felt and tape and would be a suitable candidate for this offloading system. I have used it with various types of wound dressings and have found it to be useful for plantar pressure redistribution. Overall, patients tolerate it well.

Reference

1. Robinson L, Vlahovic T, et al. The combined effect of the offloading felt pad system and a novel powder wound dressing on plantar ulcers. Poster presentation. American Podiatric Medical Association Annual Meeting. Seattle. July 15-18, 2010.



djfellnersays: October 29, 2012 at 1:36 pm

Such a technique forms part of the regular offloading strategy in the U.K. podiatry clinic. That it should be considered novel is interesting but not surprising. My observation and comparison is that of a U.S. MS4 podiatry student and also with 20 years experience of U.K. podiatry. In chair offloading, such as described here, is favored in the U.K. but is less so in the U.S. clinics, at least those venues that I have had exposure to.

Back in 'Old Blighty,' our clinics also favored the removable Scotch cast boot. This also features a treatment window cut into the walking cast. A very effective, albeit time consuming appliance.

The explanation for the different treatment approach relies, at least in part, on the funding pathway. With a majority of U.K. podiatry clinics nestled within the National Health Service (i.e. socialized healthcare) (free at the point of delivery and 'sometimes' with funding & budget restriction), clinicians will adopt, out of necessity, a different treatment plan, resources and methodology.

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