Research: Care Delivery
Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration
Article first published online: 14 NOV 2012
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK
Volume 29, Issue 12, pages 1542–1549, December 2012
How to Cite
Waaijman, R., Arts, M. L. J., Haspels, R., Busch-Westbroek, T. E., Nollet, F. and Bus, S. A. (2012), Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration. Diabetic Medicine, 29: 1542–1549. doi: 10.1111/j.1464-5491.2012.03700.x
- Issue published online: 14 NOV 2012
- Article first published online: 14 NOV 2012
- Accepted manuscript online: 30 APR 2012 12:30AM EST
- Accepted 26 April 2012
Diabet. Med. 29, 1542–1549 (2012)
Aims To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes.
Methods Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy, and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure > 200 kPa) were targeted for pressure reduction (goal: > 25% relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications, pressures were measured. In a subgroup of 32 patients, pressures were measured and, if needed, footwear was modified at 3-monthly visits for 1 year. Pressures were compared with those measured in 32 control patients who had no footwear modifications based on pressure analysis.
Results At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23%, 21% and 15%, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 24–28%, compared with pressures in the control group.
Conclusion The offloading capacity of custom-made footwear for high-risk patients can be effectively improved and preserved using in-shoe plantar pressure analysis as guidance tool for footwear modification. This provides a useful approach to obtain better offloading footwear that may reduce the risk for pressure-related diabetic foot ulcers.