M L J Arts1, M de Haart1, R Waaijman1, R Dahmen2, H Berendsen3, F Nollet1, S A Bus1. 1. Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Rehabilitation Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. 3. Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands.
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.
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.
Authors: Peter A Lazzarini; Ryan T Crews; Jaap J van Netten; Sicco A Bus; Malindu E Fernando; Paul J Chadwick; Bijan Najafi Journal: J Diabetes Sci Technol Date: 2019-04-29
Authors: Jennefer B J Zwaferink; Wim Custers; Irma Paardekooper; Heleen A Berendsen; Sicco A Bus Journal: PLoS One Date: 2020-04-23 Impact factor: 3.240
Authors: Qiu-Qiong Shi; Pui-Ling Li; Kit-Lun Yick; Jiao Jiao; Qi-Long Liu Journal: Int J Environ Res Public Health Date: 2022-09-30 Impact factor: 4.614
Authors: Jaap J van Netten; Peter A Lazzarini; David G Armstrong; Sicco A Bus; Robert Fitridge; Keith Harding; Ewan Kinnear; Matthew Malone; Hylton B Menz; Byron M Perrin; Klaas Postema; Jenny Prentice; Karl-Heinz Schott; Paul R Wraight Journal: J Foot Ankle Res Date: 2018-01-15 Impact factor: 2.303