Patients with diabetic neuropathy and foot deformity showed the highest offloading success rates of custom-made footwear at known high-risk locations, such as previous ulcer locations and Charcot feet. The lowest success rates, however, were found in forefoot deformities, according to a recently published study.
“Together with the large inter-subject variability in pressure outcomes, these results emphasize the need for evidence-based prescription and evaluation procedures to assure adequate offloading,” the researchers stated in the study.
Plantar pressures walking barefoot and inside new custom-made footwear were measured in 171 patients with diabetic neuropathy with foot deformity and a recently healed plantar foot ulcer. Researchers compared in-shoe pressures with non-deformed feet at the previous ulcer location and at locations of highest barefoot pressure attributable to the deformity. When in-shoe peak pressure was less than 200 kPa in previous ulcer location and locations of highest barefoot pressure, the footwear was considered effective in offloading.
In feet with forefoot deformity, mean in-shoe peak pressures ranged between 211 kPa and 308 kPa vs. 191 kPa to 222 kPa in non-deformed feet. Mean in-shoe peak pressures ranged from 140 kPa and 187 kPa in feet with midfoot deformity vs. 112 kPa in non-deformed feet. According to study results, offloading was effective in 61% of all feet with deformity, 81% of feet with midfoot deformity, 44% of feet with forefoot deformity and 62% of previous ulcer locations. Researchers found a large inter-subject variability in measured in-shoe plantar pressure.
For more information:
Arts MLJ, Waaijman R, De Haart M, et al. Offloading effect of therapeutic footwear in patients with diabetic neuropathy at high risk for plantar foot ulceration. Diabet Med. 2012.
Disclosure: The researchers report no relevant financial disclosures.
