Abstract

Patients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk. The aim of this systematic review is to investigate the effects of plantar offloading devices used for ulcer prevention on their role in static and dynamic balance control in patients with DPN. PubMed and Embase were systematically searched using relevant search terms. After title selection, abstract selection, and full-text selection only five articles could be included for further analysis. Two articles included static balance measurements, two articles included dynamic balance measurements, and one article included both. Results suggested that static balance control is reduced when rocker bottom shoes and different insole configurations are used, however, toe-only rockers showed less evidence for reduced static balance control. There was no evidence for reduced dynamic balance control in combination with offloading devices. However, these results should be interpreted with care, since the number of studies was very small and the quality of the studies was moderate. Future research should evaluate balance in combination with different offloading devices, so that clinicians subscribing them are more aware of their potential unwanted consequences.

Highlights

  • Diabetes mellitus (DM) is a major problem worldwide, especially among elderly

  • Older people with DM experience higher fall risks compared to healthy older people [6]

  • This systematic review aimed to study the effects of plantar offloading devices used for prevention of diabetic foot ulcers (DFU) on static and dynamic balance control

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Summary

Introduction

Diabetes mellitus (DM) is a major problem worldwide, especially among elderly. Diabetic patients are prone to develop neuropathy at their feet and ankles [1]. The incidence of diabetic peripheral neuropathy (DPN) among newly diagnosed diabetic patients is approximately 30% [2]. This increases to approximately 50% in patients diagnosed with DM for more than 20 years [3]. Patients with DPN are at higher risk of falling compared to healthy older adults [9]. Other studies in healthy people found similar balance reductions as patients with DPN, Rev Endocr Metab Disord (2021) 22:325–335 e.g. when the feet of healthy people were placed in an ice bath [4]. This temporarily decreases somatosensory information from the feet. Besides reduced balance in patients with DPN, offloading devices such as insoles or diabetic footwear influence pressure distribution, afferent somatosensory information, and perception in patients with DPN [10, 11], which may negatively influence balance control in patients with DPN

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