Off-loading 減壓-Half shoes 半鞋

游朝慶 醫師

   雖然已有許多隨機研究顯示TCC治療效果遠優於half shoes半鞋^1,2，但半鞋仍有其他的優勢，如便宜，相對於TCC一次更換石膏要花費$50–75，一副RCW要價$150–200，一副半鞋卻只要$25–75²。

Figure —
A significant difference in cumulative wound survival was noted at 12 weeks between patients treated with a TCC half-shoe and a RCW (Aircast). P = 0.012 and 0.033, respectively.¹
而甚麼是半鞋呢？如下圖，就長的鞋子被切一半的樣子。

圖1.半鞋

圖2.Darco Heel Wedge Healing Shoe $30.60
http://www.wayfair.com/Darco-International-Heel-Wedge-Healing-Shoe-1448-DRI1013.html

圖3.Darco OrthoWedge Shoe $18.50
http://www.dme-direct.com/ortho-wedge-orthowedge-darco-shoe

   Bus等人³研究四種前足減壓鞋forefoot offloading shoes(FOS，如下圖)，也就是半鞋的減壓效果，決果發現FOS能降低蹠骨頭的壓力高達38-58%，所以半鞋若確實來穿的話，應該會有效，但臨床上達不到TCC的效果，我認為原因應該和RCW失敗的原因一樣，就是因為不舒服，患者會輕易脫掉鞋子，故意忘記穿上它。故若可以如i-TCC般，將半鞋鎖住或綑綁住，或許效果也會等同TCC。

圖4. Six different footwear conditions tested in the study: four different FOS models (a–d), a Mabal cast shoe (e), and a control shoe (f). For each FOS model the pivot point location of the outsole (A) expressed in percentage of total shoe length measured from the heel is shown together with the difference in measured height from the ground between the base (heel, B) and the tip (toes, C) of the support surface of the shoe.³
   這種半鞋，許多廠商卻稱呼其為post-OP shoes(術後鞋，矯形鞋，醫療鞋，Health shoes, surgery shoes)，post-OP shoes長得如下圖，使用在用來足部手術後或受傷後，因傷口包紮後，正常鞋子穿不下，而暫時使用的替代鞋。我們較常稱呼為石膏鞋cast shoes，顧名思義，就是打上石膏後，為保護石膏而須穿上的特殊鞋(至於為何有人稱呼它為小叮噹鞋就不得而知了)，而半鞋剛好也長得像這種術後鞋，故在國外一些醫療器材網站也把半鞋歸在於術後鞋這一大種類中。

圖5.post-OP shoes
1. Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB., Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001 Jun;24(6):1019-22.
2. Ha Van G, Siney H, Hartmann-Heurtier A, Jacqueminet S, Greau F, Grimaldi A. Nonremovable, windowed, fiberglass cast boot in the treatment of diabetic plantar ulcers: efficacy, safety, and compliance. Diabetes Care. 2003 Oct;26(10):2848-52.
3. Bus SA, van Deursen RW, Kanade RV, Wissink M, Manning EA, van Baal JG, Harding KG. Plantar pressure relief in the diabetic foot using forefoot offloading shoes. Gait Posture. 2009 Jun;29(4):618-22. doi: 10.1016/j.gaitpost.2009.01.003. Epub 2009 Feb 13.