August 2013

Removable plug insoles significantly reduce pressure, as do arch supports

In the moment: Diabetes

By Emily Delzell

Researchers from Taiwan confirmed that insoles with removable plugs reduce forefoot plantar pressures in patients with diabetic neuropathy, and those pressures are further reduced by adding arch support.

Investigators from Taichung Veterans General Hospital in Taiwan identified the forefoot region with the highest mean peak pressure (MPP), defined as the region of interest (ROI), in 26 participants with diabetic neuropathy. In 22 participants baseline MPP in the ROI exceeded 200 kPa, which is often used as a threshold indicating ulceration risk and the need for offloading.

They tested ROIs under three conditions: a foam-based insole prior to plug removal, after removal of the plug corresponding to the ROI, and postplug removal with an added prefabricated latex arch support.

Compared with baseline measures, plug removal resulted in a significant 32.3% reduction in MPP, lowering it below 200 kPa in 23 ROIs; adding arch support reduced MPP another 9.5%, lowering it below 200 kPa in all ROIs. There were no significant changes in MPP at other areas of the foot.

Findings were epublished in July by the Journal of Foot and Ankle Research.


Lin TL, Sheen HM, Chung CT, et al. The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy. J Foot Ankle Res 2013;6(1):29.

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