Abstract
ObjectiveThis study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice.Research design and methodsPatient-specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data. Changes in forefoot plantar pressure were investigated when 60 people with diabetes and neuropathy walked in nine variants of the orthotic insole. These comprised three variations in proximal/distal location of the customised metatarsal bar and three different metatarsal head offloading materials.Results & conclusionsThe most frequent reductions in pressure occurred when the anterior edge of the metatarsal bar was placed at 77% of the peak pressure values, and its effects were independent of the choice of EVA or Poron offloading material. In the flat insole, 61% of participants had one or more metatarsal head areas with pressure above the 200 KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested. Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet.
Highlights
Foot ulceration is estimated to affect 0.5–3% of the global population of people with diabetes [1] and the forefoot is the most commonly affected [2]
61% of participants had one or more metatarsal head areas with pressure above the 200 KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested
Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet
Summary
Foot ulceration is estimated to affect 0.5–3% of the global population of people with diabetes [1] and the forefoot is the most commonly affected [2]. Designed footwear is proven to reduce forefoot plantar pressures [6, 7] and risk of re-ulceration [8], but poor adherence is a key barrier to clinical success [9, 10]. Problems with adherence are likely to be more relevant for people without a history of ulceration because they may not consider themselves at risk [12]. They may, be less motivated to change their footwear from aesthetically pleasing retail shoes to pressure relieving designs incorporating stiff rocker soles or extra forefoot depth [12, 13]. For individuals at risk of ulceration but unwilling or unable to change their footwear, an orthotic insole used inside a retail shoe may still offer some protection against the risk of ulceration [14]
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