Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes

Abstract

OBJECTIVE -High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.RESEARCH DESIGN AND METHODS -Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40 -80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas. RESULTS-The results showed a significant increase in maximum foot contact area of 11 cm 2 (95% CI 7-11) when subjects wore the PFC socks (P Ͻ 0.01). This was accompanied by 5.4 kPa (3.5-7.3) or 9% reduction in total foot pressure (P Ͻ 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.CONCLUSIONS -These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients. Diabetes Care 28:2001-2006, 2005T he personal and health care costs associated with diabetic foot ulcers are well recognized. It has been estimated that ϳ2% of the diabetic population will have an active foot ulcer (1) and a similar proportion will develop a new lesion each year (1,2). Many factors are associated with the development of foot ulcers including neuropathy, deformity, and trauma (3,4). It is also recognized that although neuropathy is a major contributory factor in the development of ulcers, the ulcer is usually preceded by unrecognized minor tissue damage, commonly from footwear (5). It is not surprising, therefore, that footwear is considered to be an important and modifiable risk factor for foot ulceration.The main stresses that act upon the feet are step shock, pressure, friction, and shear. These stresses often occur together to damage insensitive and delicate foot structures.Step shock is the impact force generated by the body, particularly as the foot makes initial contact with the ground. This impact force is thought to be associated with a variety of bone and soft tissue disorders affecting the foot as well as other structures in the body (6). Not only have high plantar pressures been implicated in the development of foot ulcers (7,8) but also the offloading of diabetic foot ulcers is now also considered to be an essential component of foot wound management (9 -11). Friction is the static or active force that acts on the skin and resists slid...

Immediate Effects of Contralateral and Ipsilateral Cane Use On Normal Adult Gait

“…However, this may reflect the limitations of our small group size and the fact that the participants did not wear standardized footwear during gait testing with the Pedar‐X plantar pressure measurement system. In‐shoe plantar pressure measurements may be affected by foot structure (shape and mobility) and by characteristics of the hosiery and footwear such as heel height, degree of cushioning, and sole stiffness [25‐27]. Future studies with larger sample sizes and uniform footwear (of same brand/model) may be better able to detect any subtle regional plantar pressure differences.…”

The Biomechanics of the Foot in Diabetes Mellitus

“…339 As was noted earlier, socks can also markedly reduce friction between the foot and the shoe, 50 indicating an additional reason why they may exert a beneficial action.…”

Plantar pressure sensing using loop antenna sensors

“…This loss of sensation on the plantar surface is a complication of diabetes. It is widely believed that the factors contributing to the ulceration are plantar pressure and shear distribution [3][4][5]. The aim of this project is to design a pressure sensing device that can predict and alert when the patient is at a high risk for ulceration.…”