• 1.

    McIntosh A, Peters J, Young R, et al: Prevention and Management of Foot Problems in Type 2 Diabetes: Clinical Guidelines and Evidence, University of Sheffield, Sheffield, England, 2004.

    • Search Google Scholar
    • Export Citation
  • 2.

    Macfarlane DJ, Jensen JL: Factors in diabetic footwear compliance. JAPMA 93: 485, 2003.

  • 3.

    Abbott C, Vileikyte L, Williamson S, et al: Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care 21: 1071, 1998.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Kastenbauer T, Sauseng S, Sokol G, et al: A prospective study of predictors for foot ulceration in type 2 diabetes. JAPMA 91: 343, 2001.

    • Search Google Scholar
    • Export Citation
  • 5.

    Peters EJ, Lavery LA; International Working Group on the Diabetic Foot: Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care 24: 1442, 2001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Caselli A, Pham H, Giurini J, et al: The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care 25: 1066, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Lavery LA, Armstrong DG, Wunderlich RP, et al: Predictive value of foot pressure assessment as part of a population based diabetes disease management program. Diabetes Care 26: 1069, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Stess R, Jensen S, Mirmiran R: The role of dynamic plantar pressures in diabetic foot ulcers. Diabetes Care 20: 855, 1997.

  • 9.

    Bennett PJ, Stocks AE, Whittam DJ: Analysis of risk factors for neuropathic foot ulceration in diabetes mellitus. JAPMA 86: 113, 1996.

  • 10.

    Boulton AJ, Betts RP, Franks CI, et al: The natural history of foot pressure abnormalities in neuropathic diabetic subjects. Diabetes Res 5: 73, 1987.

  • 11.

    Spencer S: Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database Syst Rev 3: CD002302, 2000.

    • Search Google Scholar
    • Export Citation
  • 12.

    Pitei D, Lord M, Foster A, et al: Plantar pressures are elevated in the neuroischemic and the neuropathic diabetic foot. Diabetes Care 22: 1966, 1999.

  • 13.

    Grimm A, Kastenbauer T, Sauseng S, et al: Progression and distribution of plantar pressure in type 2 diabetic patients. Diabetes Nutr Metab 17: 108, 2004.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Foto JG, Birke JA: Evaluation of multidensity orthotic materials used in footwear for patients with diabetes. Foot Ankle Int 19: 836, 1998.

  • 15.

    Sanders J, Greve J, Mitchell S, et al: Material properties of commonly-used interface materials and their static coefficiants of friction with skin and socks. J Rehabil Res Dev 35: 161, 1998.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Brodsky J, Kouroch S, Stills M, et al: Objective evaluation of insert material for diabetic and athletic footwear. Foot Ankle 9: 111, 1988.

  • 17.

    Lobmann R, Kayser R, Kasten G, et al: Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study. Diabet Med 18: 314, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Olaleye D, Perkins B, Bril V: Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract 54: 115, 2001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Perkins B, Olaleye D, Zinman B, et al: Simple screening tests for peripheral neuropathy in the diabetic clinic. Diabetes Care 24: 250, 2001.

  • 20.

    Cowley MS, Boyko EJ, Shofer JB, et al: Foot ulcer risk and location in relation to prospective clinical assessment of foot shape and mobility among persons with diabetes. Diabetes Res Clin Pract 82: 226, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 21.

    Mohamed O, Cerny K, Rojek L, et al: The effects of PLASTAZOTE and ALIPLAST/PLASTAZOTE orthoses on plantar pressures in elderly persons with diabetic neuropathy. J Prosthet Orthot 16: 55, 2004.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Paton J, Jones RB, Stenhouse E, et al: The physical characteristics of materials used in the manufacture of orthoses for patients with diabetes. Foot Ankle Int 28: 1057, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 23.

    Chantelau E, Haage P: An audit of cushioned diabetic footwear: relation to patient compliance. Diabet Med 11: 114, 1994.

  • 24.

    Knowles E, Boulton A: Do people with diabetes wear prescribed footwear. Diabet Med 13: 1064, 1996.

A Longitudinal Investigation into the Functional and Physical Durability of Insoles Used for the Preventive Management of Neuropathic Diabetic Feet

View More View Less
  • 1 Faculty of Health and Human Sciences, Plymouth University, Plymouth, England.
  • | 2 Department of Podiatry, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, England.
  • | 3 Faculty of Health and Social Work, University of Plymouth, Plymouth, England.
Restricted access

Background

Insoles are commonly used to assist in the prevention of diabetic neuropathic foot ulceration. Insole replacement is often triggered only when foot lesions deteriorate, an indicator that functional performance is comprised and patients are exposed to unnecessary ulcer risk. We investigated the durability of insoles used for ulcer prevention in neuropathic diabetic feet over 12 months.

Methods

Sixty neuropathic individuals with diabetes were provided with insoles and footwear. Insole durability over 12 months was evaluated using an in-shoe pressure measurement device and through repeated measurement of material depth at the first metatarsal head and the heel seat. Analysis of variance was performed to assess change across time (at issue, 6 months, and 12 months).

Results

Analyses were conducted using all available data (n = 43) and compliant data (n = 18). No significant difference was found in the reduction of mean peak pressure tested across time (P < .05). For both sites, significant differences in insole depth were identified between issue and 6 months and between issue and 12 months but not between 6 and 12 months (P < .05). Most insole compression occurred during the initial 6 months.

Conclusions

Visual material compression does not seem to be a reliable indicator of insole usefulness. Frequency of insole replacement is best informed by a functional review of effect determined using an in-shoe pressure measurement system. These results suggest that insoles for diabetic neuropathic patients can be effective in maintaining peak pressure reduction for 12 months regardless of wear frequency.

Corresponding author: Joanne S. Paton, PhD, Faculty of Health and Human Sciences, Plymouth University, FF21 Peninsula Allied Health Centre, Derriford Road, Plymouth, PL6 9BH, England. (E-mail: joanne.paton@plymouth.ac.uk)