The Role of Footwear in the Prevention of Foot Lesions in Patients With NIDDM: Conventional wisdom or evidence-based practice?

Litzelman, Debra K.; Marriott, Deanna J.; Vinicor, Frank

doi:10.2337/diacare.20.2.156

Cited by 78 publications

(42 citation statements)

References 7 publications

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“…Plantar pressures and shoe use (treatment adherence) were not measured in either of these studies. Another large RCT investigated the recommendation for footwear within the context of a multi-faceted educational intervention [6]. Owing to methodological flaws, no relevant conclusions could be drawn from this study.…”

Section: Footwearmentioning

confidence: 65%

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Bus

Valk

Deursen

et al. 2008

Diabetes Metab. Res. Rev.

219

182

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SummaryBackground Footwear and offloading techniques are commonly used in clinical practice for the prevention and treatment of foot ulcers in diabetes, but the evidence base to support this use is not well known. The goal of this review was to systematically assess the literature and to determine the available evidence on the use of footwear and offloading interventions for ulcer prevention, ulcer treatment, and plantar pressure reduction in the diabetic foot.

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Section: Footwearmentioning

confidence: 65%

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Bus

Valk

Deursen

et al. 2008

Diabetes Metab. Res. Rev.

219

182

View full text Add to dashboard Cite

show abstract

“…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).…”

mentioning

confidence: 99%

Therapeutic Footwear for the Neuropathic Foot: An algorithm

Dahmen

Haspels²,

Koomen³

et al. 2001

Diabetes Care

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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...

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“…Cavanagh commented that he believed that "therapeutic footwear is the most important feature of a recurrence program" but pointed out that this has not yet been proven. Indeed, a prescription for therapeutic footwear is actually a risk factor for ulcer development, presumably because clinicians have identified at-risk patients for such treatment (2). Part of the problem is that not all therapeutic shoes given in the community are effective.…”

Section: Mechanics Of Ulcer Healing and Preventionmentioning

confidence: 99%

American Diabetes Association 60th Scientific Sessions, 2000

Bloomgarden

2001

Diabetes Care

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The Role of Footwear in the Prevention of Foot Lesions in Patients With NIDDM: Conventional wisdom or evidence-based practice?

Abstract: Many variables commonly cited as protective measures in footwear for diabetic patients were not prospectively predictive when controlling for physiological risk factors. Rigorous analyses are needed to examine the many assumptions regarding footwear recommendations for diabetic patients.

Cited by 78 publications

References 7 publications

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Therapeutic Footwear for the Neuropathic Foot: An algorithm

American Diabetes Association 60th Scientific Sessions, 2000

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