Reduction of Abnormal Foot Pressures in Diabetic Neuropathy Using a New Polymer Insole Material

Abstract

The precise pressures and loads under 69 neuropathic feet have been measured during walking using a modified microprocessor-controlled optical system. Abnormally high pressures were demonstrated in 94% of feet with a history of foot ulceration, with pressures as high as 20-30 kg X cm-2 under the forefoot. All subjects were also studied using a new visco-elastic polymer material recently used for insole manufacture. A reduction in pressure was demonstrated that was proportional to peak pressure (linear regression line correlation coefficient of 0.91; P less than 0.001). We conclude that this material causes a significant reduction in the abnormally high pressures recorded under neuropathic feet, and should provide a useful insole for the management of patients at risk of neuropathic foot ulceration.

Preventive Foot Care in People With Diabetes

“…Athletic running shoes decreased plantar callus formation in a group of people with diabetes, reducing the need for debridement by threefold and reducing the number of people complaining of painful callus from 70 to 9% (180). Cushioned inserts of viscoelastic polymer decreased focal pressure by about half (181). A customized molded insert allows maximum foot and insole contact, reducing focal areas of increased pressure more than a flat insert (182).…”

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

“…CONCLUSIONS-Many studies have linked high plantar pressures to sites of ulceration in diabetic individuals with neuropathy(14,16). Brand (3) identified neuropathy, abnormal pressures, and repetitive trauma as important causative factors in the development of foot ulcers.…”

Body Mass is a Poor Predictor of Peak Plantar Pressure in Diabetic Men

“…Ctercteko et al (1) found that plantar pressures in diabetic patients with ulcers were greater than in nondiabetic control subjects even when expressed as a percentage of body mass, and they concluded that factors other than body mass must act to produce higher stresses. Boulton et al (2,7) found that diabetic patients with ulcers were heavier than those without ulcers, but the patients with ulcers also had a longer duration of peripheral neuropathy, which has been implicated in causing structural changes in the feet (8). Boulton et al (5) have stated that foot pressures are not usually abnormal in heavier people and cited a grossly obese patient (body mass 138 kg) with completely normal foot pressure results.…”