Therapeutic Footwear Can Reduce Plantar Pressures in Patients With Diabetes and Transmetatarsal Amputation

Mueller, Michael J.; Strube, Michael; Allen, Bradley S.

doi:10.2337/diacare.20.4.637

Cited by 74 publications

(33 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…So far, research has focused only on parts of the problem, mostly pressure reduction (5-8), although in addition to peak pressure, the duration of maximum pressure and shear stress are also important (9 -11). Diabetic footwear has been discussed in descriptive articles (12, 13) and technical studies (8,14). However, the authors confine themselves to specific aspects like pressure distribution and rocker-bottom outsoles (8,14).…”

Section: Diabetes Care 24:705-709 2001mentioning

confidence: 99%

“…Diabetic footwear has been discussed in descriptive articles (12, 13) and technical studies (8,14). However, the authors confine themselves to specific aspects like pressure distribution and rocker-bottom outsoles (8,14). A comprehensive conceptual approach for the management of the various aspects of this footwear problem is still lacking (15).…”

Section: Diabetes Care 24:705-709 2001mentioning

confidence: 99%

“…This is achieved by making a rocker-bottom sole with an early pivot point (13,14). Maximal fixation of the foot in the shoe is obtained by using the three point principle: forces are transmitted through a stiff sole, leg, and tongue.…”

Section: Forefoot Amputationmentioning

confidence: 99%

“…aspects like pressure distribution and rocker-bottom outsoles (8,14). A comprehensive conceptual approach for the management of the various aspects of this footwear problem is still lacking (15).…”

mentioning

confidence: 99%

See 3 more Smart Citations

Therapeutic Footwear for the Neuropathic Foot: An algorithm

Dahmen

Haspels²,

Koomen³

et al. 2001

Diabetes Care

View full text Add to dashboard Cite

Neuropathy may bring about changes in form and function of the foot, which may lead to ulceration and progressive deformity. These manifestations often require specially adapted footwear. A comprehensive concept of the medical, functional, and technical requirements for this type of footwear is still lacking to date. In this article, we present an algorithm that should facilitate prescription and manufacture of adequate shoes. This algorithm attempts to establish a link between the requirements from a medical and functional point of view and the technical possibilities of orthopedic shoe technology. Diabetes Care 24:705-709, 2001T he neuropathic foot is characterized by loss of peripheral nerve function, which can be sensory, motor, autonomic or, usually, a combination of these. This loss of function causes changes in the form and function of the foot and may lead to ulceration and severe deformity, which eventually may result in amputation (1). Therefore, protection of the foot is of the greatest importance. In addition to a careful lifestyle, appropriate footwear is essential for achieving this protection (1,2).In medical literature on the neuropathic foot, much has been written about the prevention of complications. The importance of "good footwear" is stressed, though frequently without further specification (3,4). So far, research has focused only on parts of the problem, mostly pressure reduction (5-8), although in addition to peak pressure, the duration of maximum pressure and shear stress are also important (9 -11). Diabetic footwear has been discussed in descriptive articles (12, 13) and technical studies (8,14). However, the authors confine themselves to specific aspects like pressure distribution and rocker-bottom outsoles (8,14). A comprehensive conceptual approach for the management of the various aspects of this footwear problem is still lacking (15). The rationale behind footwear prescriptions is often unclear to patients and healthcare workers alike, and this can diminish compliance (3,16).The aim of this article is to describe the relationship between medical requirements and technical possibilities. For this purpose, we have developed an algorithm. A number of its components are evidencebased, but most are opinion-based, because testing the effects of therapeutic footwear is impossible without clear guidelines. This algorithm aims at establishing guidelines for clinical treatment and further research into this complex subject. REQUIREMENTS BASED ON MEDICAL FEATURESAltered biomechanics in the foot may lead to ulceration and progressive deformity (17). Here, we will only discuss the different features of a neuropathic foot. Because neuropathy commonly occurs in diabetes, we will also mention one of its consequences, limited joint mobility, which is not directly related to neuropathy (18). Sensory dysfunction Loss of sensory functionIn the long term, reduction of sensory function may lead to complete loss of sensation in the foot. We speak of loss of protective sensation when the patient is not aw...

show abstract

Section: Diabetes Care 24:705-709 2001mentioning

confidence: 99%

Section: Diabetes Care 24:705-709 2001mentioning

confidence: 99%

Section: Forefoot Amputationmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic Footwear for the Neuropathic Foot: An algorithm

Dahmen

Haspels²,

Koomen³

et al. 2001

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…Localized prominent areas resulting from skeletal deformities are most affected by mechanical stress. Therapeutic footwear is thought to be a frontline defense modality for reducing harmful stress and thus preventing the occurrence or recurrence of neuropathic plantar ulceration [4][5][6][7][8]. Equally important is the foot/shoe interface, namely the orthosis, which has been shown to effectively reduce forefoot pressures when compared with a shoe without an orthosis [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Compact and portable digitally controlled device for testing footwear materials: Technical note

Foto

2008

JRRD

View full text Add to dashboard Cite

Abstract-Little or no practical decision-making data are available to the foot-care provider regarding the selection of orthotic materials used in therapeutic footwear. A device for simulating in-shoe forefoot conditions for the testing of orthosis materials is described. Materials are tested for their effectiveness by evaluating and comparing stress-strain and dynamic compression fatigue characteristics. The device, called the Cyclical Compression Tester (CCT), has been optimized for size, simplicity of construction, and cost. Application of the device ranges from the clinician deciding the useful life of single-and multidensity orthosis materials to the researcher characterizing materials for finite-element analysis modeling. This real-time CCT device and custom user interface combine to make an evaluation tool useful for testing how the pressure distribution of in-shoe materials changes over time in therapeutic footwear for those with peripheral neuropathy at risk for foot injury.

show abstract

New developments in the biomechanics of the diabetic foot

Cavanagh

Ulbrecht

Caputo

2000

Diabetes Metab. Res. Rev.

114

View full text Add to dashboard Cite

Biomechanical issues are now widely recognized as being important in the treatment of diabetic foot disease. The purpose of the present review is to identify advances that have occurred since the previous International Conference on the Diabetic Foot in 1995 in the understanding of foot biomechanics in relation to diabetes. Attention continues to be focused on the identification of a threshold plantar pressure that leads to tissue damage. Recent studies have suggested that peak barefoot pressure may be only 65% specific for the development of ulceration. The association between foot deformity and plantar pressure has been the subject of several quantitative studies, but new questions have been raised about the etiology of claw toes. The measurement of shear stress continues to be an elusive goal although several small studies have presented possibly feasible technical approaches. The importance of callus as a precursor to ulceration has been confirmed experimentally and quantitative measures of motor neuropathy have been presented. Although a number of new devices have been introduced as alternatives to the Total Contact Cast, few clinical studies of their efficacy are available yet. New information on the properties of insole materials has been published including data on changes with repeated cycling. Complications of prophylactic surgery have been shown to include a high rate of Charcot fractures. Two new series describing the fixation of such fractures have also been reported. Biomechanical issues have also been addressed in two sets of guidelines for treatment that have recently been published. These many studies confirm the central role of mechanical stress and its relief in the treatment of neuropathic foot problems in diabetes.

show abstract

Therapeutic Footwear Can Reduce Plantar Pressures in Patients With Diabetes and Transmetatarsal Amputation

Abstract: The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.

Cited by 74 publications

References 15 publications

Therapeutic Footwear for the Neuropathic Foot: An algorithm

Therapeutic Footwear for the Neuropathic Foot: An algorithm

Compact and portable digitally controlled device for testing footwear materials: Technical note

New developments in the biomechanics of the diabetic foot

Contact Info

Product

Resources

About