{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:08Z","timestamp":1783509308989,"version":"3.55.0"},"reference-count":20,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Diabetic foot ulcers are associated with a 12-fold increased risk of lower-extremity amputations and increased mortality rates. Off-loading is one of the many crucial interventions involved in healing diabetic foot ulcers. This study investigates various off-loading devices: total-contact cast (TCC), removable TCC (R-TCC) with and without brace, and removable controlled ankle motion walker, with further subdivision of plantar foot regions.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Previously collected deidentified data of 12 healthy participants from a study by Bhatt et al were used in the present study. Peak plantar pressure (PPP) of nine individual mask regions for each off-loading device were imported into a statistical software program for analysis.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Removable controlled ankle motion walker, TCC, and R-TCC with brace had significant PPP reductions compared with controls in eight of the nine regions of the foot, except for the nonsignificant increase in PPP of the medial midfoot region. The R-TCC with brace had a nonsignificant PPP reduction difference compared with the TCC for six of the nine regions.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    This study found new discoveries by further expanding on studies by Bhatt et al and subdividing the plantar foot into nine regions. The TCC remains the gold standard and first line of treatment for off-loading diabetic foot ulcers. These findings contradict those previously reported by Bhatt et al.\n                  <\/jats:p>","DOI":"10.7547\/21-119","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T11:18:55Z","timestamp":1750850335000},"source":"Crossref","is-referenced-by-count":0,"title":["Removable and Nonremovable Off-Loading Devices"],"prefix":"10.3390","volume":"115","author":[{"given":"Sarah L.","family":"Carter","sequence":"first","affiliation":[{"name":"School of Allied Health, The University of Western Australia, Crawley, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine H. M.","family":"Law","sequence":"additional","affiliation":[{"name":"School of Allied Health, The University of Western Australia, Crawley, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Seyler","sequence":"additional","affiliation":[{"name":"School of Allied Health, The University of Western Australia, Crawley, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixuan","family":"Tian","sequence":"additional","affiliation":[{"name":"School of Allied Health, The University of Western Australia, Crawley, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Widjajana","sequence":"additional","affiliation":[{"name":"School of Allied Health, The University of Western Australia, Crawley, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Schoen","sequence":"additional","affiliation":[{"name":"School of Allied Health, The University of Western Australia, Crawley, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","year":"2019","unstructured":"International Diabetes Federation: IDF Diabetes Atlas, Ninth Edition. Available at: https:\/\/diabetesatlas.org\/upload\/resources\/material\/20200302_133351_IDFATLAS9e-final-web.pdf. Published 2019. Accessed September 2020."},{"key":"B2","series-title":"PLoS One","first-page":"e0181916","article-title":"Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up","volume":"12","author":"Fernando ME","year":"2017","unstructured":"Fernando ME, Crowther RG, Lazzarini PA, et al: Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up. PLoS One 12: e0181916, 2017."},{"key":"B3","series-title":"Bone Joint Res","first-page":"373","article-title":"Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy","volume":"7","author":"Johnson-Lynn S","year":"2018","unstructured":"Johnson-Lynn S, McCaskie A, Coll A, et al: Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy. Bone Joint Res 7: 373, 2018."},{"key":"B4","series-title":"Foot Ankle Int","first-page":"1108","article-title":"Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration","volume":"35","author":"Wukich DK","year":"2014","unstructured":"Wukich DK, Raspovic KM, Hobizal KB, et al: Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int 35: 1108, 2014."},{"key":"B5","series-title":"Curr Diab Rep","first-page":"74","article-title":"Updates on diabetic foot and Charcot osteopathic arthropathy","volume":"18","author":"Schmidt BM","year":"2018","unstructured":"Schmidt BM, Holmes CM: Updates on diabetic foot and Charcot osteopathic arthropathy. Curr Diab Rep 18: 74, 2018."},{"key":"B6","series-title":"Clin Podiatr Med Surg","first-page":"663","article-title":"Charcot neuroarthropathy advances: understanding pathogenesis and medical and surgical management","volume":"36","author":"Botek G","year":"2019","unstructured":"Botek G, Figas S, Narra S: Charcot neuroarthropathy advances: understanding pathogenesis and medical and surgical management. Clin Podiatr Med Surg 36: 663, 2019."},{"key":"B7","series-title":"Diabetes Metab Res Rev","first-page":"3274","article-title":"Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Bus SA","year":"2019","unstructured":"Bus SA, Armstrong DG, Gooday C, et al: Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36: 3274, 2019."},{"key":"B8","first-page":"1214","article-title":"Plantar pressure changes in diabetic peripheral neuropathy","volume":"32","author":"Ri HC","year":"2019","unstructured":"Ri HC, Hwang SH, Ho CJ, et al: Plantar pressure changes in diabetic peripheral neuropathy 32: 1214, 2019."},{"key":"B9","series-title":"Gait Posture","first-page":"379","article-title":"Calculation of plantar pressure time integral, an alternative approach","volume":"34","author":"Melai T","year":"2011","unstructured":"Melai T, Ijzerman TH, Schaper NC, et al: Calculation of plantar pressure time integral, an alternative approach. Gait Posture 34: 379, 2011."},{"key":"B10","series-title":"Diabetes Metab Res Rev","first-page":"574","article-title":"Predictive factors for diabetic foot ulceration: a systematic review","volume":"28","author":"Monteiro-Soares M","year":"2012","unstructured":"Monteiro-Soares M, Boyko EJ, Ribeiro J, et al: Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev 28: 574, 2012."},{"key":"B11","series-title":"J Foot Ankle Res","first-page":"1","article-title":"Reduction of peak plantar pressure in people with diabetes-related peripheral neuropathy: an evaluation of the DH Pressure Relief Shoe\u2122","volume":"5","author":"Raspovic A","year":"2012","unstructured":"Raspovic A, Landorf KB, Gazarek J, et al: Reduction of peak plantar pressure in people with diabetes-related peripheral neuropathy: an evaluation of the DH Pressure Relief Shoe\u2122. J Foot Ankle Res 5: 1, 2012."},{"key":"B12","series-title":"Plast Reconstr Surg","first-page":"179","article-title":"The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence","volume":"138","author":"Bus SA","year":"2016","unstructured":"Bus SA: The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence. Plast Reconstr Surg 138: 179, 2016."},{"key":"B13","series-title":"Chronic Wound Care Manag Res","first-page":"83","article-title":"Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission","volume":"4","author":"Boghossian JA","year":"2017","unstructured":"Boghossian JA, Miller JD, Armstrong DG: Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission. Chronic Wound Care Manag Res 4: 83, 2017."},{"key":"B14","article-title":"Following the evidence for total contact casting as first-line treatment of DFUs in the wound clinic. Today\u2019s Wound Clinic","author":"Applewhite AJ","year":"2016","unstructured":"Applewhite AJ: Following the evidence for total contact casting as first-line treatment of DFUs in the wound clinic. Today\u2019s Wound Clinic. Available at: https:\/\/www.todayswoundclinic.com\/articles\/following-evidence-total-contact-casting-first-line-treatment-dfus-wound-clinic. Published October 2016. Accessed October 10, 2020."},{"key":"B15","series-title":"JAPMA","first-page":"1","article-title":"Is TCC-EZ a suitable alternative to gold standard total-contact casting?","volume":"111","author":"Bhatt UK","year":"2021","unstructured":"Bhatt UK, Foo HY, McEvoy MP, et al: Is TCC-EZ a suitable alternative to gold standard total-contact casting? JAPMA 111: 1, 2021."},{"key":"B16","series-title":"J Diabetes Complications","first-page":"621","article-title":"Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location","volume":"27","author":"Ledoux WR","year":"2013","unstructured":"Ledoux WR, Shofer JB, Cowley MS, et al: Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location. J Diabetes Complications 27: 621, 2013."},{"key":"B17","year":"2011","unstructured":"Novel GmbH: Pedar\u00ae-X System Manual. Available at: https:\/\/www.scribd.com\/document\/489344473\/pedar-x-v20-English-MANUAL. Published 2011. Accessed September 28, 2019."},{"key":"B18","series-title":"Int J Dermatol","first-page":"e383","article-title":"Neuropathic ulcers: a focused review","volume":"60","author":"Urso B","year":"2021","unstructured":"Urso B, Ghias M, John A, et al: Neuropathic ulcers: a focused review. Int J Dermatol 60: e383, 2021."},{"issue":"suppl 1","key":"B19","series-title":"Diabetes Metab Res Rev","first-page":"e3266","article-title":"Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)","volume":"36","author":"Schaper NC","year":"2020","unstructured":"Schaper NC, van Netten JJ, Apelqvist J, et al: Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev 36(suppl 1): e3266, 2020."},{"key":"B20","series-title":"BMJ Open Diabetes Res Care","first-page":"e002640","article-title":"Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers","volume":"10","author":"Ababneh A","year":"2022","unstructured":"Ababneh A, Finlayson K, Edwards H, et al: Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers. BMJ Open Diabetes Res Care 10: e002640, 2022."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/115\/3\/21-119.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/3\/21-119.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/3\/21-119.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:20:05Z","timestamp":1783506005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/115\/3\/21119"}},"subtitle":["A Plantar Pressure Analysis"],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":20,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.7547\/21-119","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}