Shear-Reducing Insoles to Prevent Foot Ulceration in High-Risk Diabetic Patients

Lavery, Lawrence A.; LaFontaine, Javier; Higgins, Kevin R.; Lanctot, Dan R.; Constantinides, George

doi:10.1097/01.asw.0000422625.17407.93

Cited by 60 publications

(94 citation statements)

References 25 publications

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“…Effect sizes were large (46.1–63.6% relative risk reduction compared with standard of care therapeutic footwear), but 95% CIs show that effect may vary across patients. These data confirm earlier findings in three RCTs with mixed methodological quality on the efficacy of therapeutic footwear (relative risk reductions compared with control condition: 52.5–70.2%) . One other RCT at low risk of bias assessed the effect of therapeutic insoles and showed no significant effect on ulcer recurrence compared with standard footwear (relative risk reduction 12%) .…”

Section: Therapeutic Footwearsupporting

confidence: 86%

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Bus

Armstrong

Deursen

et al. 2016

Diabetes Metabolism Res

175

196

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RecommendationsCasting and prefabricated healing devices 1. To heal a neuropathic plantar forefoot ulcer without ischemia or uncontrolled infection in a patient with diabetes, offload with a non-removable knee-high device with an appropriate foot-device interface. (GRADE strength of recommendation: strong, Quality of evidence: high) 2. When a non-removable knee-high device is contraindicated or not tolerated by the patient, consider offloading with a removable knee-high walker with an appropriate foot-device interface to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the device. (Weak; Moderate) 3. When a knee-high device is contraindicated or cannot be tolerated by the patient, consider offloading with a forefoot offloading shoe, cast shoe, or custom-made temporary shoe to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the shoes. (Weak; Low) Therapeutic footwear4. To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) 5. Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent nonplantar ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles, or toe orthosis. (Strong; Low) 6. To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressurerelieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) 7. Do not prescribe, and instruct a patient with diabetes not to use, conventional or standard therapeutic shoes to heal a plantar foot ulcer. (Strong; Low) 8. Consider using shoe modifications, temporary footwear, toe spacers, or

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Section: Therapeutic Footwearsupporting

confidence: 86%

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Bus

Armstrong

Deursen

et al. 2016

Diabetes Metabolism Res

175

196

View full text Add to dashboard Cite

show abstract

“…An RCT with high risk of bias by Lavery et al found in 299 patients, of whom 26% had prior ulcers, that insoles designed to reduce shear stress and were worn in extra‐depth therapeutic shoes show a trend but do not significantly reduce ulcer incidence after 18 months compared with standard insoles: 2.0% vs 6.7% ( p = 0.08) . Another RCT with high risk of bias from Rizzo et al involved the initial randomization of 298 patients, 20% with previous ulceration, to intensive footwear therapy based on a prescription algorithm or standard care consisting of footwear advice but no footwear prescription.…”

Section: Resultsmentioning

confidence: 99%

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Netten

Raspovic

Lavery

et al. 2016

Diabetes Metabolism Res

291

226

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Background Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration.

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“…Previous work has suggested that shear-reducing insoles are helpful for preventing DFU in high-risk persons [13]. In contrast, a study on active DFU that compared a removable cast walker containing a shear-reducing foot bed to two other offloading modalities found the shear-reducing cast walker yielded the lowest healing and highest rate of attrition [14].…”

Section: Achieving Optimal Offloadingmentioning

confidence: 99%

Recent Advances and Future Opportunities to Address Challenges in Offloading Diabetic Feet: A Mini-Review

et al. 2018

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Diabetic foot ulcers (DFU) are a substantial dilemma for geriatric individuals with diabetes. The breakdown in tissue associated with DFU is typically a result of repetitive cycles of physical stress placed on the feet during weight-bearing activity. Accordingly, a key tenet in healing as well as preventing DFU is the use of offloading footwear to redistribute physical stress away from high stress locations such as bony prominences. Over the last several years there has been a substantial amount of effort directed at better understanding and implementing the practice of offloading. A review of this work as well as relevant technological advances is presented in this paper. Specifically, we will discuss the following topics in association with offloading diabetic feet: achieving optimal offloading, dosing activity/physical stress, thermal monitoring to detect preulcerative tissue damage, adherence with offloading devices, and optimizing the user experience. In addition to presenting progress to date, potential directions for further advancement are discussed.

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Shear-Reducing Insoles to Prevent Foot Ulceration in High-Risk Diabetic Patients

Abstract: These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.

Cited by 60 publications

References 25 publications

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Recent Advances and Future Opportunities to Address Challenges in Offloading Diabetic Feet: A Mini-Review

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