OBJECTIVE -To compare the effectiveness of different types of footwear insoles in the diabetic neuropathic foot. RESEARCH DESIGN AND METHODS-A sample of 241 consecutive diabetic patients (158 men and 83 women, age 57.5 Ϯ 9.6 years [mean Ϯ SD], and mean duration of diabetes 12.3 Ϯ 7.2 years) attending the foot clinic with previous foot ulceration and those considered at high risk of foot ulceration were included in the study. The study groups consisted of group 1, patients provided with sandals with insoles made with microcellular rubber (n ϭ 100); group 2, with sandals with polyurethane foam (n ϭ 59); group 3, with molded insoles (n ϭ 32); and group 4, with their own footwear containing leather board insoles (n ϭ 50). Neuropathy status was assessed using a biothesiometer. Plantar pressure was measured using the RS Scan inshoe pressure measurement system. Data obtained from the metatarsal heads were used as the peak pressure. The state of the sandals was assessed after 9 months. The patients were considered to have had an ulcer relapse when either a new ulcer appeared at the site of a previous one or a new foot ulcer appeared in a different area.RESULTS -Patients who were using therapeutic footwear showed lower foot pressure (group 1, 6.9 Ϯ 3.6; group 2, 6.2 Ϯ 3.9; and group 3, 6.8 Ϯ 6.1 kPa; P ϭ 0.0001), while those who used the nontherapeutic footwear showed an increased foot pressure (group 4, 40.7 Ϯ 20.5 kPa; P ϭ 0.008). The occurrence of new lesions was significantly higher in patients in group 4 (33%) when compared with that of all other groups (4%).CONCLUSION -Therapeutic footwear is useful to reduce new ulceration and consequently the amputation rate in the diabetic population. Diabetes Care 27:474 -477, 2004D iabetic foot infection is a common cause for hospital admission among diabetic patients in India. This could be attributed to several sociocultural practices, such as walking barefoot, inadequate facilities for diabetes care, poor education, and poor socioeconomic conditions (1). It was reported earlier (2) that recurrence of foot infection was common among South Indian type 2 diabetic subjects and was related to the presence of peripheral vascular disease and neuropathy. A diabetic patient with a history of previous ulceration or amputation is at an increased risk for further ulceration, infection, and subsequent amputation. Alterations in foot dynamics due to ulceration, joint deformity, or amputation can cause abnormal distribution of plantar pressures and result in the formation of a new ulcer (3). In our earlier study (4), we reported that limited joint mobility and increased plantar pressure appear to be important determinants of foot ulceration irrespective of the duration of diabetes.The reduction of pressure peaks by providing special shoes turns out to be an effective tool for managing the neuropathic foot. Data from randomized trials on the usefulness of therapeutic footwear in preventing foot ulcers varies, with some studies showing benefits (5-7) and a few others not showing any benefic...

With the aim of developing an ideal bone graft, a new bone grafting material was developed using deglued bone, chitosan and gelatin. Deglued bone (DGB) which is a by-product of bone glue industries and has the close crystallographic similarities of hydroxyapatite was used as main component in the preparation of bone implant. Chitosan was prepared from the exoskeleton of prawn (Pinaeus indicus, family Crustaceae) which is a by-product of seafood industries. Chitosan gives toughness to the product and do not allow the DGB particles to wither away when the implant is placed in the defect. Gelatin was used as binder for the preparation of DGBchitosan composite. The DGB, chitosan and DGB-chitosan-gelatin composite, which were prepared in the laboratory, were analysed for their physicochemical properties by infrared spectroscopy, X-ray diffraction and scanning electron microscopy studies.

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The aim of this research work is to prepare biodegradable polyurethane composites and study their physical, mechanical, thermal and biodegradation properties. Rigid biodegradable polyester based polyurethane was synthesized by reacting excess of isocyanate with poly(ε-caprolactone) diol to obtain prepolymer which was then reacted with chain extender. Polyurethane composites are prepared with nanoclay and titanium(IV)oxide nanopowder in different concentrations and PU containing 2% W/W of nanopowder had shown better properties. Biodegradation studies showed that the developed polyurethane materials when used as shoe soles will retain their strength while storage and use but will decompose only after disposal into the environment.