An Audit of Cushioned Diabetic Footwear: Relation to Patient Compliance

Chantelau, Ernst; Haage, Patrick

doi:10.1111/j.1464-5491.1994.tb00240.x

Cited by 125 publications

(111 citation statements)

References 5 publications

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“…Nevertheless, this type of shoe cannot completely reduce pressure in the ulcerated zone when the patient is walking or standing upright (13,14). It must be emphasized that the effectiveness of the shoe also depends on how long the patient wears it (15). Therefore, the effectiveness of this device is strictly related to patient compliance and the training and information given by the health care provider (16).…”

Section: Caravaggi and Associatesmentioning

confidence: 99%

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Caravaggi¹,

Faglia²,

Giglio³

et al. 2000

Diabetes Care

131

100

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OBJECTIVE -To evaluate and compare the rate of reduction of the surface area of neuropathic plantar ulcers in diabetic patients treated with nonremovable rigidity-differentiated fiberglass off-bearing casts or a cloth shoe with a rigid sole with unloading alkaform insoles. The secondary aim was to evaluate the side effects and degree of patient acceptance of treatment. RESEARCH DESIGN AND METHODS -Fifty diabetic patients with neuropathicplantar ulcers were consecutively enrolled and randomized to one of two treatment groups. Of the 50 patients, 24 were treated with a specialized cloth shoe with a rigid sole and an unloading alkaform insole (shoe group), and 26 patients were treated with a nonremovable off-bearing fiberglass cast (cast group). All patients in both study groups returned to the clinic for weekly control visits. Their ulcers were treated with a standard dressing. Tracings of the ulcer area using a transparent dressing were performed on the day of entry to the study and after 30 days of treatment. The presence of new ulcerations caused by the use of the pressure-relief apparatus was recorded. Patient acceptance of the treatment was measured using a visual analog scale.RESULTS -At the end of the treatment period, an 8.3% increase of the ulcer area was observed in two patients in the shoe group, whereas in the cast group, no patient presented an increase. The reduction of the ulcer area was statistically more rapid in the cast group (MannWhitney test, P = 0.0004). Furthermore, the number of ulcers completely healed at the 30-day time point was 13 (50%) in the cast group and 5 (20.8%) in the shoe group (P = 0.03). In both groups, no side effects were recorded. The average score ± SD of patient acceptance was 91.15 ± 9.9 in the shoe group and 88.33 ± 17.3 (NS) in the cast group.CONCLUSIONS -Our study has shown a significant difference in the speed of the reduction of neuropathic plantar ulcers treated with a fiberglass cast compared with a specialized cloth shoe. The use of fiberglass material with variable rigidity has also shown two important results: the elimination of side effects including ulcers caused by the cast, and high patient acceptance. These data show that the use of off-bearing casts made with fiberglass bandages of variable rigidity is the elective treatment of neuropathic plantar ulcers.

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Section: Caravaggi and Associatesmentioning

confidence: 99%

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Caravaggi¹,

Faglia²,

Giglio³

et al. 2000

Diabetes Care

131

100

View full text Add to dashboard Cite

show abstract

“…Normal stresses originate by the repetitive vertical pressure on the foot while shear stresses occur when deep tissue slides under superficial tissue. It is currently accepted that reduction of abnormally high PPP during walking helps in the prevention and treatment of neuropathic ulcerations [2,3]. In this research study, total contact inserts (TCI) were used as the offloading mechanism because multiple studies have shown that the addition of a TCI can reduce PPP 16−48% under the metatarsal heads [4][5][6][7][8] compared to therapeutic footwear alone.…”

Section: Introductionmentioning

confidence: 99%

Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking

Actis

Ventura

Lott

et al. 2008

Med Biol Eng Comput

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There is evidence that appropriate footwear is an important factor in the prevention of foot pain in otherwise healthy people or foot ulcers in people with diabetes and peripheral neuropathy. A standard care for reducing forefoot plantar pressure is the utilization of orthotic devices such as total contact inserts (TCI) with therapeutic footwear. Most neuropathic ulcers occur under the metatarsal heads, and foot deformity combined with high localized plantar pressure, appear to be the most significant factors contributing to these ulcers. In this study, patient-specific finite element models of the second ray of the foot were developed to study the influence of TCI design on peak plantar pressure (PPP) under the metatarsal heads. A typical full contact insert was modified based on the results of finite element analyses, by inserting 4 mm diameter cylindrical plugs of softer material in the regions of high pressure. Validation of the numerical model was addressed by comparing the numerical results obtained by the finite element method with measured pressure distribution in the region of the metatarsal heads for a shoe and TCI condition. Two subjects, one with a history of forefoot pain and one with diabetes and peripheral neuropathy, were tested in the laboratory while wearing therapeutic shoes and customized inserts. The study showed that customized inserts with softer plugs distributed throughout the regions of high plantar pressure reduced the PPP over that of the TCI alone. This supports the outcome as predicted by the numerical model, without causing edge effects as reported by other investigators using different plug designs, and provides a greater degree of flexibility for customizing orthotic devices than current practice allows.

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“…Chantelau et al (21,22) conducted two descriptive studies of therapeutic footwear as the primary intervention on patients with diabetic foot complications (a history of polyneuropathy, limb ischemia, foot ulceration, or prior forefoot or toe amputation) in a German population at moderate to high risk of reulceration. Both studies were assigned a II-3 study design rating because of their descriptive nature.…”

Section: Multifactoral Interventions Including Therapeutic Footwearmentioning

confidence: 99%

“…Chantelau's second descriptive study tracked 51 patients with a history of neuropathic foot ulcers, including some patients from the 1990 study, to assess the influence of patient's footwear adherence on reulceration risk (22). All 51 patients were provided custom shoes with plastazote, neoprene, and poron inserts (Fig.…”

Section: Multifactoral Interventions Including Therapeutic Footwearmentioning

confidence: 99%

Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration

et al. 2004

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OBJECTIVE -To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors.RESEARCH DESIGN AND METHODS -We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study population, components of the intervention, and level of adherence were evaluated. U.S. Preventive Services Task Force criteria for evaluating research were applied to rate each study on study design and internal validity.RESULTS -Risk ratios in all studies assessing the association between therapeutic footwear and reulceration were below 1.0, suggesting some protective footwear benefit. However, in the most rigorous experimental study, no statistically significant benefit was observed between control patients wearing their own footwear and intervention patients wearing study footwear. Annual reulceration in these studies' control groups ranged from 8.4 to 59.3%. In patients with severe foot deformity or prior toe or ray amputation, observational studies suggested a significant protective benefit from therapeutic footwear.CONCLUSIONS -Therapeutic footwear has been used for decades as one of many strategies to prevent reulceration in patients with diabetes and foot risk factors. The findings of several studies reporting statistically significant protective effects from therapeutic footwear may have been influenced by several design issues. When considering the appropriateness of therapeutic footwear recommendations for moderate-risk patients, clinicians and patients should jointly explore individual strategies to decrease events that lead to foot ulcers. Diabetes Care 27:1774 -1782, 2004P reventing foot ulcers in individuals with diabetes is a major clinical objective for diabetes care providers because foot ulcers can lead to lower-limb amputations. In a study of causal pathways to amputation, Pecoraro et al. (1) reported that ulcers preceded 84% of diabetes-related amputations. In 1997, 68% of U.S. amputations were in individuals with diabetes. Of these diabetesrelated amputations, 53% involved toes and feet and 47% were at the transtibial or transfemoral level (2). Efforts to prevent ulcers and reulceration may avoid serious sequelae that reduce patients' quality of life and increase their health care costs (3).Published strategies for preventing reulceration include multidisciplinary foot care, debridement of callus and nails, patient self-management education, and therapeutic footwear because foot ulcers and amputations have been attributed to poorly fitting footwear (1,4 -7). Therapeutic footwear was publicized as a way to prevent ulcers, amputations, hospitalizations, and costs when Congress approved this benefit contingent on a demonstration study showing cost savings or cost neutrality (8,9).Clinical recommendations for people with diabetes include provision of special footwear to individuals with diab...

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An Audit of Cushioned Diabetic Footwear: Relation to Patient Compliance

Cited by 125 publications

References 5 publications

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking

Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration

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