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Offloading the diabetic foot using forefoot offloading shoes

Researchers

  • Sicco Bus (Diabetic Foot Unit, Dept of Surgery, Twenteborg Hospital, Almelo, the Netherlands)
  • Rajani Kanade
  • Michelle Evans
  • Marieke Wissink (Diabetic Foot Unit, Dept of Surgery, Twenteborg Hospital, Almelo, the Netherlands)
  • Prof. Patricia Price (Wound Healing Research Unit, School of Medicine, Cardiff University)
  • Prof. Keith Harding (Wound Healing Research Unit, School of Medicine, Cardiff University)
  • Eric Manning (Diabetic Foot Unit, Dept of Surgery, Twenteborg Hospital, Almelo, the Netherlands)
  • Sjef van Baal (Diabetic Foot Unit, Dept of Surgery, Twenteborg Hospital, Almelo, the Netherlands)
  • Dr. Robert van Deursen

Prefabricated forefoot offloading shoes (FOS) are used for ulcer treatment. However, little is known about the biomechanical effectiveness of the FOS. Therefore, the purpose of this study was to assess the effectiveness of FOS in offloading the forefoot in diabetic patients with peripheral neuropathy.

Twenty-four diabetic patients (20 men, 4 women) with peripheral neuropathy participated walked at their self-selected speed with four FOS: the Thanner Cabrio, Rattenhuber Talus, Fior&Gentz Hannover, and Fior&Gentz Luneburg, together with a Pulman orthopedic slipper used as control condition. A Mabal fiberglass cast shoe was also added for comparison. In-shoe plantar pressure was measured using the Pedar system. Peak pressure, pressure-time integral (PTI), and force-time integral (FTI) were calculated for 6 different anatomical foot regions: heel, midfoot, MTH1, MTH2-5, hallux, and lesser toes. At the MTH regions, peak pressure and PTI were significantly reduced (by 38-58%) in all FOS when compared with the control shoe. Loading (FTI) of the heel was similar between shoe conditions, but midfoot FTI was substantially increased in the FOS when compared with the control shoe (up to 162% in the F&G Luneburg).

All four FOS were equally effective in offloading the forefoot of the neuropathic diabetic patients, with only minor differences between the shoes. The action of the FOS to transfer pressure from the forefoot to proximal regions was clearly illustrated by the substantially increased midfoot loads when compared with the control shoe. Therefore, the FOS can be effective in healing forefoot plantar ulcers in neuropathic diabetic patients.