Reduction of peak plantar pressure in people with diabetes‐related peripheral neuropathy: an evaluation of the DH Pressure Relief Shoe™

Raspovic, Anita; Landorf, Karl B; Gazarek, Jana; Stark, Megan

doi:10.1186/1757-1146-5-25

Cited by 28 publications

(40 citation statements)

References 36 publications

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“…The p edar®-X system is a reliable, valid measuring system that is widely used in foot pressure research [7,15,16]. The p edar® insoles size was determined according to each individual's shoe size and calibration of the insole sensors was performed before data sampling.…”

Section: Methodsmentioning

confidence: 99%

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

Lin

Sheen

Chung

et al. 2013

Journal of Foot and Ankle Research

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BackgroundRemovable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.MethodsIn-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support).ResultsAmong the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions.ConclusionsThese findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.

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Section: Methodsmentioning

confidence: 99%

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

Lin

Sheen

Chung

et al. 2013

Journal of Foot and Ankle Research

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“…Several noncontrolled studies show that 70% to 96% of plantar foot ulcers can be healed in a reasonable time frame (mean 34‐79 d) with ankle‐high removable offloading devices, provided they are used regularly . Multiple cross‐sectional studies also consistently found that a variety of removable ankle‐high offloading devices were more effective in reducing plantar pressure at the forefoot than a variety of footwear interventions (custom‐made, therapeutic, extra‐depth, conventional, or standard footwear) . No studies were found for weight‐bearing activity or adherence.…”

Section: Recommendationsmentioning

confidence: 99%

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Armstrong

Gooday

et al. 2020

Diabetes Metabolism Res

183

432

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee‐high offloading device is the first choice of offloading treatment. A removable knee‐high and removable ankle‐high offloading device are to be considered as the second‐ and third‐choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth‐choice offloading treatment. If non‐surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.

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“…Also, forefoot offloading shoes effectively offload the forefoot and are more effective than accommodative felt and foam dressings worn in a post‐operative sandal or compared with post‐operative shoes alone . A shoe with removable insole plugs can provide significantly more pressure relief than a control shoe or the patients' own shoes . Using an insole with removable plugs and an arch support can provide even further pressure relief when compared with just using insoles with removable plugs or basic flat insoles …”

Section: Structured Education Aimed At Health Care Professionalsmentioning

confidence: 99%

Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review

Netten

Sacco

Lavery

et al. 2020

Diabetes Metabolism Res

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Background Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. Methods The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self‐management; pre‐ulcer treatment; orthotic interventions; and foot‐ and mobility‐related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre‐ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. Results We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self‐care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom‐made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot‐ and mobility‐related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. Conclusions Structured education for patients and health care professionals, callus removal, custom‐made therapeutic footwear, and foot‐ and mobility‐related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.

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Reduction of peak plantar pressure in people with diabetes‐related peripheral neuropathy: an evaluation of the DH Pressure Relief Shoe™

Cited by 28 publications

References 36 publications

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review

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