LEIPZIG, Germany — A researcher here presented data that may help orthotists and pedorthists design more effective footwear for patients with diabetic ulcers.
Sicco Bus, PhD, senior investigator, University of Amsterdam, Academic Medical Center, showed a study matrix he and his colleagues designed that combines footwear modifications with their effects on in-shoe foot pressures, and their relative ability to relieve those pressures on specific areas of the foot, compared with no treatment.
He discussed previous studies that demonstrated biomechanical findings that have contributed to footwear designed for patients with diabetes and diabetic ulcers, but he said the designs leave room for improvement.
“Very little of the knowledge we have about what is effective in pressure reduction is actually incorporated into practice,” Bus said.
To create the offloading-effect matrix, Bus and colleagues divided the foot into eight different regions and used measurements of the biomechanical effects of nine different modifications: local material removal, local material softening, top layer replacement, metatarsal pad, transmetatarsal bar, medial arch support, roller supplement, roller outsole and optimization of pad/bar position. Green areas of the matrix suggest significant pressure relief between pre-modification and post-modification, whereas red areas indicate increased pressure.
“These pressure increases are not that high and they are in regions that are less at risk for ulcers,” Bus said.
According to the matrix, replacing the top cover results in pressure relief across all eight areas of the foot, while adding a metatarsal pad was shown to relieve pressure in the entire metatarsal region. Adjusting the roller outsole provided significant pressure relief on the hallux, digits 4-5 and metatarsal regions 2-3 and 4-5. Optimizing the pad/bar position resulted in the most significant improvement at metatarsal region 1. Medial arch support only showed significant pressure relief in metatarsal region 1.
“This matrix can be used in practice not only for modifying footwear but for designing footwear that can be used by the doctor and shoe technician to see how effective orthopedic shoewear can be created in terms of relieving significant risk areas from pressure,” Bus said. The study has been submitted for publication. — by Carey Cowles
For more information:
Bus S. Influence of biomechanical research findings on treatment strategies of orthopaedic shoes for diabetic patients. Presented at: OT World Congress; May 12-16, 2014; Leipzig, Germany.
Disclosure: Bus has no relevant financial disclosures.