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- Title
Data-driven directions for effective footwear provision for the high-risk diabetic foot.
- Authors
Arts, M. L. J.; Haart, M.; Waaijman, R.; Dahmen, R.; Berendsen, H.; Nollet, F.; Bus, S. A.
- Abstract
Aims Custom-made footwear is used to offload the diabetic foot to prevent plantar foot ulcers. This prospective study evaluates the offloading effects of modifying custom-made footwear and aims to provide data-driven directions for the provision of effectively offloading footwear in clinical practice. Methods Eighty-five people with diabetic neuropathy and a recently healed plantar foot ulcer, who participated in a clinical trial on footwear effectiveness, had their custom-made footwear evaluated with in-shoe plantar pressure measurements at three-monthly intervals. Footwear was modified when peak pressure was ≥ 200 kPa. The effect of single and combined footwear modifications on in-shoe peak pressure at these high-pressure target locations was assessed. Results All footwear modifications significantly reduced peak pressure at the target locations compared with pre-modification levels (range -6.7% to -24.0%, P < 0.001). The metatarsal heads were most frequently targeted. Repositioning an existing (trans-)metatarsal pad in the shoe insole (-15.9% peak pressure relief), applying local cushioning to the insole (-15.0%) and replacing the insole top cover with Plastazote (-14.2%) were the most effective single modifications. Combining a new Plastazote top cover with a trans-metatarsal bar (-24.0% peak pressure relief) or with local cushioning (-22.0%) were the most effective combined modifications. Conclusions In people with diabetic neuropathy and a recently healed plantar foot ulcer, significant offloading can be achieved at high-risk foot regions by modifying custom-made footwear. These results provide data-driven directions for the design and evaluation of custom-made footwear for high-risk people with diabetes, and essentially mean that each shoe prescribed should incorporate those design features that effectively offload the foot.
- Subjects
FOOT anatomy; FOOT ulcers; TYPE 2 diabetes diagnosis; TYPE 1 diabetes; CHARCOT-Marie-Tooth disease; AMPUTATION; DEMOGRAPHY; PEOPLE with diabetes; ETHNIC groups; FOOT abnormalities; GLYCOSYLATED hemoglobin; LONGITUDINAL method; ORTHOPEDIC shoes; SHOES; DATA analysis; DIABETIC foot; BODY mass index; DISEASE risk factors; PREVENTION; DIAGNOSIS
- Publication
Diabetic Medicine, 2015, Vol 32, Issue 6, p790
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.12741