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Data‐driven directions for effective footwear provision for the high‐risk diabetic foot
Author(s) -
Arts M. L. J.,
Haart M.,
Waaijman R.,
Dahmen R.,
Berendsen H.,
Nollet F.,
Bus S. A.
Publication year - 2015
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12741
Subject(s) - medicine , cushioning , foot (prosody) , diabetic foot , foot pressure , physical medicine and rehabilitation , plantar pressure , physical therapy , diabetes mellitus , pressure sensor , engineering , mechanical engineering , philosophy , linguistics , endocrinology , structural engineering
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 kP a. 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.