Abstract
BackgroundRemovable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.MethodsIn-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support).ResultsAmong the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions.ConclusionsThese findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.
Highlights
Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure
Insole plugs were removed under the site of a current ulcer in one patient, the site of a previous ulcer that had healed in 3 patients, and under the 1st metatarso-phalangeal joint in 10 patients who had no ulcer history but had high plantar pressure
In 22 of the 26 region of interest (ROI), mean peak pressure (MPP) at baseline were higher than 200 kPa
Summary
Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. Raspovic et al reported quantitative evidence of pressure reduction using the DH Pressure Relief ShoeTM in patients with diabetic neuropathic feet [7]. It has been suggested that offloading modalities with removable plug design, including walkers and shoes, may be useful in clinical practice [7,8]. The value to use additional insole accessories such as an arch support in insoles with removable plug design has not been tested. The aim of this study was to evaluate the following effects on plantar pressure by: (i) insole plug removal; and (ii) additional use of an arch support in patients with diabetic neuropathic feet
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