To prevent the occurrence or reoccurrence of foot ulcers, custom-made therapeutic footwear is often prescribed to offload pressure areas in patients with diabetic neuropathy, foot deformity, and a healed planter foot ulcer. A study completed by researchers from the Netherlands aimed to evaluate the offloading effect of custom-made footwear for patients with these presentations. They stated that the “outcomes suggest that improvement in footwear design is required and should focus most on those deformities that affect pressure in the metatarsal region.” The study was published in the U.K.-based journal Diabetic Medicine.
According to the abstract, plantar pressures walking barefoot and inside new custom-made footwear were measured for 171 patients (336 feet) with diabetic neuropathy with foot deformity and a recently healed plantar foot ulcer. At the previous ulcer location and at locations of highest barefoot pressure attributable to the deformity, in-shoe pressures were compared with non-deformed feet. Results indicated that offloading was effective in 61 percent of all feet with deformity, 81 percent of feet with midfoot deformity, 44 percent of feet with forefoot deformity, and 62 percent of previous ulcer locations. Inter-subject variability in measured in-shoe plantar pressure was large.
The researchers concluded that offloading of custom-made footwear is often not sufficiently achieved in high-risk diabetic feet with deformity. Further, highest offloading success rates were seen at known high-risk locations such as previous ulcer locations and Charcot feet, the lowest success rates in forefoot deformities. Together with the large inter-subject variability in pressure outcomes, the researchers emphasized the need for evidence-based prescription and evaluation procedures to assure adequate offloading.
Editor’s note: This story was adapted from materials provided by Diabetic Medicine.
