Pressure-reduction and preservation in custom-made footwear of patients with diabetes

NewsBot · May 1, 2012

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Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration.
Waaijman R, Arts ML, Haspels R, Busch-Westbroek TE, Nollet F, Bus SA.
Diabet Med. 2012 Apr 30.

Aims To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes.

Methods Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure > 200 kPa) were targeted for pressure reduction (goal: > 25% relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications pressures were measured. In a subgroup of 32 patients, pressures were measured and, if needed, footwear was modified at 3-monthly visits for 1 year. Pressures were compared with those measured in 32 control patients who had no footwear modifications based on pressure analysis.

Results At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23%, 21% and 15%, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 24-28%, compared with pressures in the control group.

Conclusion The offloading capacity of custom-made footwear for high-risk patients can be effectively improved and preserved using in-shoe plantar pressure analysis as guidance tool for footwear modification. This provides a useful approach to obtain better offloading footwear that may reduce the risk for pressure-related diabetic foot ulcers
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Boots n all · May 1, 2012

How can we get the full text please NewsBot.

In the abstract it doesnt say what the modification is, it does say "Footwear modification", where l would have said "Sole modification" if it was just the sole been modified?

Then, if it was sole modification, this would apply to most footwear not just custom, as most shoes can be modified with a rocker sole, pressure mapped and adjusted accordingly.

l think l am safe to say rocker sole, but hey, you never know

Admin2 · May 2, 2012

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Other thread tagged with therapeutic footwear

NewsBot · May 17, 2020

Optimised cushioning in diabetic footwear can significantly enhance their capacity to reduce plantar pressure
Panagiotis E.Chatzistergos et al
Gait & Posture; 17 May 2020

Highlights
•Correct selection of cushioning stiffness significantly improves pressure reduction
•Patient specific selection can maximise pressure reduction in diabetic feet
•Patient specific optimum stiffness was correlated to the participants’ body weight
•Stiffer cushioning materials were needed for higher magnitudes of loading
•Further research is needed for clinically applicable optimisation of cushioning
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Background
Plantar pressure reduction with the use of cushioning materials play an important role in the clinical management of the diabetic foot. Previous studies in people without diabetes have shown that appropriate selection of the stiffness of such materials can significantly enhance their capacity to reduce pressure. However the significance of optimised cushioning has not been yet assessed for people with diabetic foot syndrome.

Research question: What is the potential benefit of using footwear with optimised cushioning, with regards to plantar pressure reduction, in people with diabetes and peripheral neuropathy?

Methods
Plantar pressure distribution was measured during walking for fifteen people with diabetic foot syndrome in a cohort observational study. The participants were asked to walk in the same type of footwear that was fitted with 3D-printed footbeds. These footbeds were used to change the stiffness of the entire sole-complex of the shoe; from very soft to very stiff. The stiffness that achieved the highest pressure reduction relative to a no-footbed condition was identified as the patient-specific optimum one.

Results
The use of the patient-specific optimum stiffness reduced, on average, peak pressure by 46% (± 14%). Using the same stiffness across all participants reduced pressure reduction by at least nine percentile points (37% ± 17%); a statistically significant difference (paired samples t-test, t(13)= -3.733, p = 0.003, d = 0.997). Pearson correlation analysis also indicated that patient-specific optimum stiffness was significantly correlated with the participants’ body mass index (BMI), with stiffer materials needed for people with higher BMI (rs(14) = 0.609, p = 0.021).

Significance
This study offers the first quantitative evidence in support of optimising cushioning in diabetic footwear as part of standard clinical practice. Further research is needed to develop a clinically applicable method to help professionals working with diabetic feet identify the optimum cushioning stiffness on a patient-specific basis.
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NewsBot · Jul 25, 2022

Baropodometric comparison of orthopedic footwear to assess the effectiveness of pairs of orthopedic shoes for reducing the forefoot pressure
Hasan Basri Sezer, Alexandre Hardy, Ronny Lopes
Jt Dis Relat Surg. 2022;33(2):323-329

Objectives: This study aimed to evaluate the distribution of foot pressure with the most frequently used orthopedic shoes and demonstrate the effect of offloading philosophy on the pressure distributions of rocker bottom or heel support shoes applied unilaterally or bilaterally.

Materials and methods: Three bilateral and four unilateral, a total of seven shoe designs with sensors included in the insole were tested by the same subject in a standard acquisition protocol. Two of the unilateral and one of the bilateral shoes had heel support, while others had a rocker bottom design. A descriptive analysis was performed for each shoe and compared to a reference value obtained from a standard shoe.

Results: Shoes with an offloading heel resulted in a greater reduction in pressure on the forefoot than other models. All other shoes increased pressure on the first metatarsophalangeal joint. Heel offloading models performed the best in forefoot offloading, and bilateral heel offloading shoes performed the best in first metatarsal offloading, with the highest scores of 83% and 82%, respectively.

Conclusion: This study showed that orthopedic shoes sold in pairs could reduce pressure on the forefoot at a comparable level to unilateral shoes. It supports their use to limit the disadvantages of single orthopedic shoes, such as limb length discrepancies.
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