Researchers at the Universidad Complutense de Madrid, Spain, have concluded that customized orthotic therapy to off-load plantar pressures in patients with recurrent diabetes-related foot ulcers significantly decreased the reulceration rate and peak plantar pressures. The results of the two-year study were published in the July/August 2013 edition of the Journal of the American Podiatric Medical Association.
After completing a detailed biomechanical study of 117 participants with diabetes, the researchers prescribed therapeutic insoles and footwear. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear. The researchers also compared reulceration rates, minor amputation rates, and work and daily living activities before and after therapy.
Before treatment, the reulceration rate was 79 percent and the amputation rate was 54 percent. After two years of orthotic therapy, the reulceration rate was 15 percent and the amputation rate was 6 percent. Orthotic therapy reduced peak plantar pressures in patients with and without reulcerations, although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Absence from work was reduced from 100 percent to 26 percent.