Armstrong DG, Lavery LA, Quebedeaux TL, et al: Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults. .South Med J90::384. ,1997. .9114827)| false
Wrobel JS, Mayfield JA, Reiber GE: Geographic variation of lower-extremity major amputation in individuals with and without diabetes in the Medicare population. .Diabetes Care24::860. ,2001. .11347744)| false
Katz IA, Harlan A, Miranda-Palma B, et al: A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. .Diabetes Care28::555. ,2005. .15735187)| false
Advani A, Marshall SM, Thomas TH: Impaired neutrophil actin assembly causes persistent CD11b expression and reduced primary granule exocytosis in Type II diabetes. .Diabetologia45::719. ,2002. .12107753)| false
Alvarez OM, Rogers RS, Booker JG, et al: Effect of noncontact normothermic wound therapy on the healing of neuropathic (diabetic) foot ulcers: an interim analysis of 20 patients. .J Foot Ankle Surg42::30. ,2003. .
Alvarez OM, Rogers RS, Booker JG, et al: Effect of noncontact normothermic wound therapy on the healing of neuropathic (diabetic) foot ulcers: an interim analysis of 20 patients. .J Foot Ankle Surg42::30. ,2003. .12567365)| false
Bruce DG, Davis WA, Starkstein SE, et al: A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study. .Diabetologia48::2532. ,2005. .16292463)| false
Background: Exercise has not been studied extensively in persons with active neuropathic diabetic foot wounds, primarily because a device does not exist that allows patients to exercise while sufficiently off-loading pressure at the ulcer site. The purpose of this project was to demonstrate a device that reduces cycling plantar forefoot pressure.
Methods: Ten healthy participants rode a recumbent bicycle under three cycling conditions. While the left foot interaction remained constant with a standard gym shoe and pedal, the right foot was exposed to a control condition with standard gym shoe and pedal, gym shoe and specialized cleat, and gym shoe with an off-loading insole and specialized cleat. Pressure and contact area of the plantar aspect of the feet were recorded for a 10-sec interval once during each minute of each condition’s 7-min trial.
Results: The off-loading insole and specialized cleat condition yielded significantly lower (P < .01) peak pressure, contact area, and pressure–time integral values in the forefoot than the specialized cleat condition with gym shoe, which yielded significantly lower values (P < .01) than the standard gym shoe and pedal.
Conclusion: Modifications to footwear may alter plantar forefoot pressures, contact area, and pressure–time integrals while cycling. The CLEAR Cleat could play a significant role in the facilitation of fitness in patients with (or at high risk for) neuropathic wounds. (J Am Podiatr Med Assoc 98(4): 261–267, 2008)
Corresponding author: Erin Klein, DPM, MS, Scholl’s CLEAR, 3333 Green Bay Rd, North Chicago, IL 60064. (E-mail: firstname.lastname@example.org)