May 2017

Shoe closure technique affects thermal stress response in at-risk individuals

In the moment: Diabetes

By Jordana Bieze Foster

Shoelace closure technique can affect plantar thermal stress response (TSR) in patients with diabetic peripheral neuropathy, according to a study from Baylor College of Medicine in Houston, TX, that has implications for foot ulcer prevention.

In 15 patients with diabetic neuropathy, researchers assessed plantar TSR for the left foot (shoe laced as the patient habitually would) and for three shoe-closure conditions on the right foot (laced tightly, laced loosely, and with a preset reel-clutch closure).

TSR for each condition was calculated from thermal images obtained after five minutes of acclimatization and after walking 200 steps.

Compared with the habitual lacing technique, plantar TSR was significantly higher for the loose and tight conditions (70% and 67% higher, respectively). Plantar TSR was significantly (206.5%) lower for the reel-clutch condition than patients’ habitual lacing technique, which suggests a preset closure setting might be the best option for minimizing TSR in patients with diabetic neuropathy. The findings were epublished in April by the Journal of Diabetes Science and Technology.


Rahemi H, Armstrong DG, Enriquez A, et al. Lace up for healthy feet: The impact of shoe closure on plantar stress response. J Diab Sci Tech 2017 Apr 18. [Epub ahead of print]

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