Reducing Plantar Pressure in the Neuropathic Foot: A comparison of footwear

Lavery, Lawrence A.; Vela, Steven A.; Fleischli, John G.; Armstrong, David G.; Lavery, David C.

doi:10.2337/diacare.20.11.1706

Cited by 140 publications

(82 citation statements)

References 11 publications

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“…Several studies have found that increased contact area reduces plantar pressure in the forefoot by 35-44% (3,4,(13)(14)(15)(16)(17). Although in our study the use of an individualized EVA insole inside an Xtra depth shoe increased the effective contact area between foot and insole, this did not result in significant pressure reductions underneath the forefoot.…”

Section: Vas Scorescontrasting

confidence: 46%

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

2003

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OBJECTIVE -The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.RESEARCH DESIGN AND METHODS -Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.RESULTS -Shoes with a rocker bottom principle reduced pressure 35-65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.CONCLUSIONS -The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases. Diabetes Care 26:441-445, 2003B auman et al. (1) were among the first researchers who published their study on the relationship between high-pressure areas and plantar ulceration in the insensitive foot. They appreciated the effect of both a total contact cast and certain orthopedic shoes on the healing process of neuropathic ulcers. They investigated the effect of shoe sole design on plantar pressure reduction using small pressure sensors taped to specific areas underneath the sole of the foot.Using similar equipment 25 years later, Nawoczenski et al. (2) showed that certain pivotal and curved rocker bottom shoes were able to effectively reduce forefoot pressure in normal subjects. Many studies have followed since then (rev. in 3). However, despite all the pioneering work, different disciplines dealing with the neuropathic foot often still disagree about which therapeutic shoe modalities to prescribe. In the Netherlands, also, this is a continuing topic of dispute. Although some strongly propagate the use of custom made (orthopedic) shoes with a stiff sole and rocker bar to prevent recurrence of a neuropathic ulcer, others recommend the use of an extra depth shoe. It has been argued that these less heavy, more cosmetically attractive shoes would be at least as effective in preventing recurrence of neuropathic ulcers.According to Spencer, "There is a need to measure the effectiveness of the range of pressure relieving interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount of poor quality research in this area" (3). The present study was performed to investigate the relation between shoe design and pressure reduction in the context of the above discussion. Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured usin...

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Section: Vas Scorescontrasting

confidence: 46%

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

2003

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“…A avaliação dos pés constitui-se em passo fundamental na identificação dos fatores de risco que podem ser modificados, o que, conseqüen-temente, reduzirá o risco de ulceração e amputação de membros inferiores nas pessoas com diabetes (30) . Autores destacam que a diminuição da sensação protetora, caracterizada pela redução da sensação dolorosa de trauma na pele (3,(32)(33)(34)(35)(36)(37) , bem como a ausência parcial ou total do reflexo Aquileu (14,26,(38)(39) constituem sinais precoces de futuros processos ulcerativos nos pés, significando alto risco para o desenvolvimento de complicações. Ambas as alterações podem ser avaliadas mediante testes que utilizam vários tipos de instrumentos, desde os mais sofisticados aos mais simples.…”

Section: Avaliação Dos Pés E Prevenção De Complicaçõesunclassified

“…Dentre essas intervenções, salienta-se o uso constante de calçados apropriados de acordo com a necessidade de cada pessoa. Estudos apontam que os pontos de alta pressão, calosidades, deformidades nos pés, amputação de dedos, ou mesmo transmetatarsianos, são problemas que podem ser corrigidos com calçados confortáveis ou confeccionados sob medida, coadjuvados com palmilhas (9,(20)(21)25,30,34,37,46) . Estudo prospectivo, realizado em hospital de ensino para avaliar pessoas com diabetes de alto risco, identificou menor recorrência de ulcerações no grupo que havia recebido calçados especialmente confeccionados (55) .…”

Section: Avaliação Dos Pés E Prevenção De Complicaçõesunclassified

Pé diabético: estratégias para prevenção

Ochoa-Vigo

Pace

2005

Acta paul. enferm.

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Ochoa-Vigo K, Pace AE. Pé diabético: estratégias para prevenção. Acta Paul Enferm 2005; 18(1):100-9.RESUMO: Aproximadamente 50% das amputações não-traumáticas em membros inferiores ocorrem entre pessoas com diabetes. As amputações são precedidas por úlceras, caracterizadas por lesões cutâneas, com perda do epitélio, que podem estender-se até a derme ou chegar a tecidos profundos. As úlceras, geralmente, são acompanhadas de insensibilidade por neuropatia periférica crônica e associadas a pequenos traumas que se originam do uso de calçados inapropriados, dermatoses comuns ou manipulações incorretas dos pés. O objetivo deste estudo é descrever as principais estratégias para avaliar fatores de risco que conduzem ao desenvolvimento de complicações nos membros inferiores entre pessoas com diabetes, bem como considerá-las uma responsabilidade da equipe de assistência primária. É um trabalho de revisão da literatura, com ênfase na avaliação dos pés como medida preventiva fundamental, para identificar, precocemente, as alterações neurológica e vascular periféricas e disfunções biomecânicas. Destaca-se a avaliação dos calçados como fator externo.

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“…Four articles were about use of shoes with insoles and its effect on plantar pressure; that 2 of them were RCT [25,26], and 2 cohort studies [27,28]. Four articles examined the effect of rocker in shoes on the plantar pressure in which 2 articles were case control [29,30], 1 RCT [31], and 1 article review [32].…”

Section: Plantar Pressurementioning

confidence: 99%

The Effects of Various Orthotic Treatments on the Standing and Walking Performance of Diabetic Patients

Rezaeian

Karimi

2017

PTJ

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Purpose: Today considering the high prevalence of diabetes and its associated pressure ulcers, also irreparable consequences such as amputation and death, the use of orthotic devices is increasing. A variety of devices have designed to prevent ulcers in the patients' feet, however other aspects of the treatment, especially the performance of these patients in standing and walking, which are their main daily activities, have not been considered in designing and use of orthotic devices. In addition, the differences between the available devices and their effects have not been described yet. Therefore the aim of this review article is to answer these issues. Methods:A comprehensive research was done in databases of PubMed, Google Scholar, and ISI Web of Knowledge. The keywords such as "diabetic neuropathy", "orthosis", "plantar pressure", "balance", "energy consumption", and "spatial-temporal parameters of gait" and their results were analyzed. The quality of articles were evaluated by Downs and Black tool.Results: After proper search, 245 English articles were found with the related keywords. Then, 184 articles were excluded because of a common title or incomplete text. Also, 25 articles were excluded from the study, because their contents did not relate highly to this study or have reasonable conclusion based on the findings of other articles. Eventually the results of 36 articles were examined and reported. Conclusion:This study has examined the various articles from randomized control trial to case report. Most studies emphasized on the reduction of plantar pressures and ulcer treatment with orthotic devices. A few studies are available on the effects of orthosis in standing balance and walking parameters. However, no study was found with regard to the effect of orthotic treatments on energy consumption in these patients. Because this topic is very important, it is suggested that future studies be focused on these issues.

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Reducing Plantar Pressure in the Neuropathic Foot: A comparison of footwear

Cited by 140 publications

References 11 publications

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

Pé diabético: estratégias para prevenção

The Effects of Various Orthotic Treatments on the Standing and Walking Performance of Diabetic Patients

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