Shoe modifications based on plantar pressure measurements in patients with diabetic neuropathy can substantially reduce regional elevated loading associated with ulceration risk, according to research from the Netherlands.
Investigators from the University of Amsterdam analyzed dynamic plantar pressures in 23 patients with diabetic neuropathy, all of whom wore fully customized footwear, and identified regions of interest where peak pressures exceeded 200 kPa—a previously suggested threshold for foot ulceration risk. Those data were then used to make up to three rounds of sole or insole modifications to therapeutic footwear, with the objective of reducing regional mean pressures by at least 25% and/or to below 200 kPa.
Each patient averaged 1.6 rounds of modifications, which took an average of 53 minutes. For 35 plantar regions, mean peak pressure was reduced by 30%, from 303 kPa to 208 kPa. Mean peak pressure was reduced by more than 25% in 16 regions, to below 200 kPa in seven regions, and in both respects in 12 regions.
The findings were e-published in May by Diabetes Care.