Effectiveness of diabetic insoles to reduce foot pressures

Ashry, Hisham R.; Lavery, Lawrence A.; Murdoch, Douglas P.; Frolich, Monica; Lavery, David C.

doi:10.1016/s1067-2516(97)80071-3

Cited by 88 publications

(61 citation statements)

References 9 publications

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“…This finding supports results of other studies that have found a reduction in pressure with the use of therapeutic footwear (Lord and Hosein, 1994;Kato et al, 1996;Ashry et al, 1997;Chen et al, 2003;Bus et al, 2004;Tsung et al, 2004;Mueller et al, 2006). However, this is the first study to demonstrate a decrease in ST strain at the MT head from the use of therapeutic footwear and orthotic devices.…”

Section: Discussionsupporting

confidence: 90%

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Lott

Hastings²,

Commean

et al. 2007

Clinical Biomechanics

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Background-Ground reaction forces from walking result in stress (pressure) and soft tissue strain at the plantar aspect of the foot. Excessive plantar pressure and tissue strain on the insensate foot may lead to ulceration. Our study investigated the effect of therapeutic footwear and custom-made orthotic inserts on pressure and tissue strain along the second ray of the plantar foot, and how these two variables are associated.Methods-Twenty subjects (mean age 57.3 [SD 9.3], 12 male, 8 female, body mass index 32.5 [SD 7.4]) with diabetes mellitus, peripheral neuropathy, and a history of a plantar ulcer participated. Plantar pressure data were recorded during computed tomography scans for four conditions (barefoot, shoe, shoe+total contact insert, and shoe+total contact insert+metatarsal pad). For each condition tested, tissue strain and plantar pressure were determined at the second metatarsal head and at 15 other points along the second ray. Intepretation-Footwear and orthotic devices tested in this study decreased pressure and soft tissue strain at the second ray of the foot, and these two variables were strongly related. A better understanding of the role tissue strain plays in distributing plantar forces may lead to improvements in the design of orthotic devices. Findings-Differences

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Section: Discussionsupporting

confidence: 90%

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Lott

Hastings²,

Commean

et al. 2007

Clinical Biomechanics

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“…Previous studies examined the effects of insole type and material on pressure redistribution, but few dealt specifically with the comparison of insole shapes cast under different loading conditions. Soft flat insoles have been found to reduce plantar pressure and increase contact area [23][24][25], but they were found less effective than the contoured insoles [15,22,[26][27]]. In the current study, soft flat insoles were found to reduce the mean peak pressure and to maximize contact area in the whole foot region, but significant change occurred in the PTI for all foot regions from the shoe-only condition.…”

Section: Discussionmentioning

confidence: 50%

Effectiveness of insoles on plantar pressure redistribution

Tsung¹,

Zhang²,

Mak³

et al. 2004

JRRD

134

119

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Abstract-For this study, we compared the effectiveness of different design insoles for redistributing pressure during walking for diabetic patients and for normal control subjects. Comparisons of dynamic plantar foot pressure patterns were made with different support, including shoe-only, flat insole, and three contoured insoles. We custom-molded the three contoured insoles by casting the plantar surface of the foot under the conditions of non-weight-bearing, semi-weight-bearing, and fullweight-bearing. With the F-Scan in-shoe system, the interfacial pressure distribution during walking with different plantar supports was measured at 50 Hz for 10 s. The use of insoles could significantly reduce local peak pressure and pressure-time integral and increase the contact area. Contoured insoles were significantly better than flat insoles with regard to the insole functions in reducing local peak pressures. The insole with the semi-weight-bearing foot shape can offer the greatest peak pressure reduction compared to other insole designs, especially for patients with peak pressure located at the second to third metatarsal heads.

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“…A TCI clearly is beneficial in reducing forefoot PPP [4][5][6][7][8]. Although many patients receive adequate pressure reduction from the TCI alone, some patients require greater pressure reduction due to reoccurring pain or plantar ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…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. The primary goal of the insert is to redistribute the plantar pressure from one specific location to a broader area [4,5].…”

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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Effectiveness of diabetic insoles to reduce foot pressures

Cited by 88 publications

References 9 publications

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Effectiveness of insoles on plantar pressure redistribution

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

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