Cost benefit of diabetic foot orthotics

NewsBot · Jun 17, 2014

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Reduction in Foot Ulcer Treatment Costs Using Pressure-based In-Shoe Orthoses
JAN S. ULBRECHT, TIMOTHY HURLEY, PETER R. CAVANAGH
Presented at the 74th American Diabetes Association Mtg; San Francisco; June 14-17 2014

The purpose of this study was to estimate the potential annual treatment cost savings for diabetic foot ulcers (DFUs) in the U.S. associated with use of orthoses that are custom-designed based on measured barefoot plantar pressure versus current standard of care.

DFU occurrence rates from a recently concluded single-blinded multi-center randomized controlled trial (CareFUL Prevention) were used to model the potential impact on DFU treatment costs. In the CareFUL Prevention trial occurrence of DFUs in high-risk patients with a history of forefoot plantar neuropathic ulcers were compared between groups randomized to wear orthoses custom designed based on measured barefoot plantar pressure (P) or standard of care HCPCS code A5513 inserts that are custom molded to the foot with optional modification based on clinical criteria (S). P have been previously shown to off-load the forefoot significantly better than S. The hazard ratio for the occurrence of an ulcer in S compared to P in this study was 3.4 (95%CI 1.3-8.7). Prevalence of diabetic neuropathy, forefoot DFU’s and associated treatment costs were estimated from published studies and used to model annual DFU treatment costs in the U.S. based on the use of P versus S. Costs were projected to 2013 U.S. dollars.

Applying outcomes from the CareFUL Prevention trial, potential gross DFU treatment cost savings in the U.S. was $4.5 billion annually. A sensitivity analysis estimated the range of annual cost savings to be between $1.5 and $8.7 billion. On a net cost basis (factoring the additional cost of design and fabrication of P orthoses compared to C inserts), the estimated DFU treatment cost savings per 100 high-risk patients was $375,000 annually.

Use of orthoses custom-designed based on measured barefoot plantar pressure, that both off-load and prevent forefoot DFUs better than standard of care A5513 inserts, have the potential to result in significant prevention of DFUs and therefore substantial treatment costs savings.
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Admin2 · Jun 17, 2014

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NewsBot · Jun 19, 2019

Evaluation of orthotic insoles for people with diabetes who are at-risk of first ulceration
Ana Martinez-Santos, Stephen Preece and Christopher J. Nester
Journal of Foot and Ankle Research201912:35

Objective
This study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice.

Research design and methods
Patient-specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data. Changes in forefoot plantar pressure were investigated when 60 people with diabetes and neuropathy walked in nine variants of the orthotic insole. These comprised three variations in proximal/distal location of the customised metatarsal bar and three different metatarsal head offloading materials.

Results & conclusions
The most frequent reductions in pressure occurred when the anterior edge of the metatarsal bar was placed at 77% of the peak pressure values, and its effects were independent of the choice of EVA or Poron offloading material. In the flat insole, 61% of participants had one or more metatarsal head areas with pressure above the 200 KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested. Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet.
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