Prescription Footwear Research Articles

Long-Term Effects and Impressions of Minimal Footwear in Older Adults

Introduction: Foot pathologies can lead to difficulty walking and falls in older adults. Intrinsic foot muscles contribute to the structural support and alignment of the foot and provide somatosensory input from the ground. Minimally cushioned footwear may naturally strengthen intrinsic foot muscles and enhance sensory input to the foot; however, these effects are largely unknown in older adults. Further, there is little evidence regarding the prescription of minimal footwear and the perceptions of this footwear by older adults. Methods: Twenty-four adults age ≥65 volunteered to use minimal footwear for prescribed times during daily activities for 16 weeks. The cross-sectional area (CSA) of 5 intrinsic foot muscles was measured using ultrasound imaging at baseline, 8 weeks, and 16 weeks. Semi-structured interviews were recorded regarding participants’ impressions of the footwear, the progressive wear schedule, the footwear’s effects on orthopedic-related pain, balance, and foot awareness/sensation. Results: Across the cohort, there was no significant difference in CSA of the 5 muscles after 16 weeks of minimal footwear use. Thirteen participants had clinically meaningful increased CSA of the abductor hallucis muscle (Abh). These positive responders had no significant differences in age, grip strength, foot structure, or fall risk scores compared to participants with little to no CSA change. Interview results indicated a generally positive experience with minimal footwear for 68.1% of the cohort. A large percentage of the cohort reported no difficulty with the progressive wear schedule (77.2%), no aggravation of preexisting conditions and no new pain (77.2%), improved balance (63.6%), and improved foot awareness/sensation (72.7%) with minimal footwear use. The progressive wear schedule was perceived as inconvenient by some in the first few weeks (22.8%), but resulted in mild to no adverse effects when followed as prescribed. Conclusion: Sixteen weeks of progressive minimal footwear use in older adults did not lead to changes in intrinsic foot muscle CSA; however, half of the cohort had clinically meaningful increased CSA in the Abh muscle. It is unclear what individual qualities were associated with this positive response. Older adults reported generally positive experiences with minimal footwear with self-reported improvements in balance and foot awareness/sensation. The wear schedule may have been too conservative or not long enough to produce foot muscle hypertrophy, but subjective reports suggest beneficial neuromuscular adaptations and sensory changes occurred. Future research may need a greater length of time and larger samples to further determine the effects of long-term minimal footwear use in older adults.

Evaluation of usability, adherence, and clinical efficacy of therapeutic footwear in persons with diabetes at moderate to high risk of diabetic foot ulcers: A multicenter prospective study.

To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications. A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer. Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023. Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription. All the patients included in the research were prescribed with their first pair of therapeutic footwear. Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day. The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5-8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities. Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations.

Australian evidence-based guidelines for the prevention and management of diabetes-related foot disease: a guideline summary.

Diabetes-related foot disease (DFD) - foot ulcers, infection, ischaemia - is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian guideline for DFD was outdated. We developed new Australian evidence-based guidelines for DFD by systematically adapting suitable international guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC. This article summarises the most relevant of the 98 recommendations made across six new guidelines for the general medical audience, including: prevention - screening, education, self-care, footwear, and treatments to prevent DFD; classification - classifications systems for ulcers, infection, ischaemia and auditing; peripheral artery disease (PAD) - examinations and imaging for diagnosis, severity classification, and treatments; infection - examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments; offloading - pressure offloading treatments for different ulcer types and locations; and wound healing - debridement, wound dressing selection principles and wound treatments for non-healing ulcers. For people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self-monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD.

Can the "Appropriate" Footwear Prevent Injury in Leisure-Time Running? Evidence Versus Beliefs.

Leisure-time running is one of the most popular forms of physical activity around the world. It can be practiced almost everywhere and requires mainly a pair of "appropriate" running shoes. However, the term appropriate is ambiguous, and the properties of running footwear have always generated hot debates among clinicians, coaches, and athletes, whatever the level of practice. As the main interface between the runner's foot and the ground, the shoe potentially plays an important role in managing repetitive external mechanical loads applied to the musculoskeletal system and, thus, in injury prevention. Consequently, over the last decades, running shoes have been prescribed based on matching shoe features to foot morphology. This strategy aligns with the popular belief that footwear is one of the main extrinsic factors influencing running-related injury risk. Despite a seemingly sound strategy for shoe prescription and constant progress in running-footwear technology, the injury rate remains high. Therefore, our aim in this narrative literature review is to clarify whether the prescription of appropriate footwear to prevent injury in running is evidence based, the result of logical fallacy, or just a myth. The literature presented in this review is based on a nonsystematic search of the MEDLINE database and focuses on work investigating the effect of shoe features on injury risk in runners. In addition, key elements for a proper understanding of the literature on running footwear and injury risk are addressed. In this literature review, we outline (1) the main risk factors and the mechanisms underlying the occurrence of running-related injury, (2) important methodologic considerations for generating high-level evidence, (3) the evidence regarding the influence of running-shoe features on injury risk, (4) future directions for research, and (5) final general recommendations.

A study on non-healing plantar diabetic foot ulcers to assess the effect of compliance of using customised footwear in wound healing

Background: Foot infection is one of the commonest reasons for hospital admission of individuals with diabetes in India. Prescription footwear is an intricate aspect of a treatment program, not a therapy unto itself. Custom-made footwear can only be effective in preventing diabetic foot ulcers if worn by the patient as advised. This study was done in patients who are already prescribed customised footwear and evaluated the need for compliance based on the healing of these plantar foot ulcers.Methods: 85 diabetic patients with severe neuropathy and a non-healing callus ulcer or trophic ulcer (diameter 1-3 cm) for more than 3 months were included in the study. All these patients were followed up on weekly basis for 3 months and questioned about the use of customized footwear on regular basis. At the end of three months, the healing of these foot ulcers was compared based on whether they had been compliant with the customized footwear advice.Results: Of the 85 patients, 25 (29.4%) had shown improvement in wound healing with regular use of footwear. 60 (70.5%) patients who were not using the customized footwear had not shown any improvement in the plantar ulcers. The reasons for not using the recommended footwear were many commonest being wearing footwear only when going out and not inside the home.Conclusions: Non-compliance with customised footwear is emerging as an important cause of delay in wound healing of plantar foot ulcers.

The Effect of Low Heel Raise to Forefoot Plantar Pressure in Diabetic Patients with Tight Tendon Achilles

Introduction: The purposes of this study were to investigate the effects of raising the heel to the forefoot plantar pressure (PP) in diabetic patients with or without limited ankle dorsiflexion due to tight tendon Achilles (TA). Materials and methods: Plantar pressure recordings and gait tests were performed in the two groups of subjects with diabetes (tight TA, n=17; normal TA, n=13) with the heel raised from 1 cm to 3 cm. Results: There were no significant forefoot pressure difference between both intervention groups (p < 0.05). Plantar pressure reduction was seen in the medial (10-30%) and lateral metatarsal heads (20-50%) as well as the heel (2-38%) when heel raise was increased from 1 to 3 cm. However, reciprocal pressure increase was seen at hallux (11-76%), toes (1-200%) and midfoot (22-100%) with increased heel height. Conclusion: Heel elevation up to 2 cm is recommended for footwear prescription for to diabetic patients. A higher heel raise may may cause plantar pressure elevation to the hallux which is one of the high risk regions for plantar ulceration in diabetics.

State of the art design protocol for custom made footwear for people with diabetes and peripheral neuropathy.

Supported by evidence‐based guidelines, custom‐made footwear is often prescribed to people with diabetes who are at risk for ulceration. However, these guidelines do not specify the footwear design features, despite available scientific evidence for these features. We aimed to develop a design protocol to support custom‐made footwear prescription for people with diabetes and peripheral neuropathy. The population of interest was people with diabetes who are at moderate‐to‐high risk of developing a foot ulcer, for whom custom‐made footwear (shoes and/or insoles) can be prescribed. A group of experts from rehabilitation medicine, orthopaedic shoe technology (pedorthics) and diabetic foot research, reviewed the scientific literature and met during 12 face‐to‐face meetings to develop a footwear design algorithm and evidence‐based pressure‐relief algorithm as parts of the protocol. Consensus was reached where evidence was not available. Fourteen domains of foot pathology in combination with loss of protective sensation were specified for the footwear design algorithm and for each domain shoe‐specific and insole (orthosis)‐specific features were defined. Most insole‐related features and some shoe‐related features were evidence based, whereas most shoe‐related features were consensus based. The pressure‐relief algorithm was evidence based using recent footwear trial data and specifically targeted patients with a healed plantar foot ulcer. These footwear design and pressure‐relief algorithms are the first of their kind and should facilitate more uniform decision making in the prescription and manufacturing of adequate shoes for moderate‐to‐high‐risk patients, reducing variation in footwear provision and improving clinical outcome in the prevention of diabetic foot ulcers.

A novel method for estimating an individual’s deviation from their habitual motion path when running

The current literature on footwear cushioning and pronation has suggested that there may not be a relationship between chronic injury risk and these parameters based on mixed findings and lack of evidence of an association with prospective injury rates. Since footwear has been designed and developed based on cushioning and pronation, we suggest that we have possibly been on a misguided path in footwear design for the last few decades. Current thought thus implies that a new method of footwear prescription is necessary if we are to guide runners toward appropriate footwear that accommodates their individual biomechanical patterns during running. Based on a series of studies investigating the response of the leg to movement and loading patterns, we developed a novel paradigm based on Nigg’s ‘preferred movement path’. The assumptions of the ‘preferred motion path’ were modified in the new method and refined as the ‘habitual motion path’. We focused on knee motion in addition to foot and ankle motion since the greatest number of injuries to runners is at the knee. We utilized a kinematic method for developing a calculation to determine the deviation of a runner’s joint motion path during running from their habitual motion path. We used this deviation as an index for the individual prescription of an appropriate running shoe. While this new method matches a runner based only on their biomechanics, there are other factors that need to be considered. For example, in footwear selection, the individual’s training and injury history in addition to the experience that the runner is seeking from their run must also be considered.

The lived experience of people with diabetes using off-the-shelf prescription footwear in Singapore: a qualitative study using interpretative phenomenological analysis

BackgroundDiabetic foot ulceration (DFUs) is increasingly prevalent in Singapore. Appropriate management is important since DFU brings with it an associated risk for lower limb amputations, high morbidity rates and costs. Footwear prescription has been a part of clinical guidelines to manage DFUs. However, adherence to prescription footwear is typically poor amongst patients. Reasons for this have been explored in Northern American and Western European studies, but not in Singapore’s context. As cultural and climate differences limit transferability of findings from existing studies to individuals in Singapore, this study aims to explore the lived experiences of participants with diabetes using prescription footwear in Singapore.MethodsThis was a qualitative study using interpretative phenomenological analysis (IPA) to understand some people’s personal experience of using off the shelf prescription footwear. A total of 8 people with diabetes who received prescription footwear as part of their diabetic foot management were recruited. All participants provided written consent and took part in a semi-structured interview lasting up to an hour. Interviews were digitally recorded, transcribed and analysed using an IPA approach.Findings and discussionThe analysis identified the super-ordinate themes of 1) security and 2) acceptance with sub-themes of 1.1) risk and 1.2) protection and 2.1) personal and social acceptance and 2.2) social and cultural acceptance respectively that inter-related to influence how participants’ made footwear decisions. This process of evaluation was portrayed to be a fluctuant one, making it difficult to predict yet necessary to understand. A modified seesaw model of adherence is suggested to explain this decision-making process.ConclusionsThe complex manner by which participants grappled with security and acceptance is often overlooked when footwear is prescribed, highlighting a need for a more collaborative clinician-patient partnership for these issues to surface in clinical practice. Furthermore, prescription footwear should be seen more holistically. Empowering patients with choice to select from a range of therapeutic yet normalised footwear could increase the level of security and acceptance they experience with its use.

Diabetic foot infection and its management: A review

Diabetic foot infections are common in patients with diabetes which leads to hospitalization and it is the most frequent cause of non-traumatic lower extremity amputation. Diagnosis of foot infections based on clinical signs and symptoms of inflammation. Infected lesion culturing discloses the pathogen and their susceptibilities. The predominant pathogen responsible for infection is gram-positive cocci, especially Staphylococci and also Streptococci. Gram-negative bacilli and anaerobes are mainly found in chronic or previously treated wounds. The infected wounds require antibiotic therapy, the agents, and duration of treatment are predicted based in the severity of infection and initial management of diabetic foot infection should do by empirical therapy which based on the susceptibility data. Preventive measures to control diabetic foot infections are patient education on foot care, glycemic control, use of prescription footwear, intensive care from a podiatrist, and evaluation of surgical interventions indicated. This article explains about Pathophysiology classification, assessing the severity and treatment of diabetic foot infections.

An Explorative Study on the Efficacy and Feasibility of the Use of Motivational Interviewing to Improve Footwear Adherence in Persons with Diabetes at High Risk for Foot Ulceration.

In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear. Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie, <80% of steps taken in prescription footwear) were randomly assigned to standard education (ie, verbal and written instructions) or to standard education plus two 45-min sessions of motivational interviewing. Adherence was objectively measured over 7 days using ankle- and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability. Median (range) baseline, 1-week, and 3-month adherence at home was 49% (6%-63%), 84% (5%-98%), and 40% (4%-80%), respectively, in the motivational interviewing group and 35% (13%-64%), 33% (15%-55%), and 31% (3%-66%), respectively, in the standard education group. Baseline, 1-week, and 3-month adherence away from home was 91% (79%-100%), 97% (62%-99%) and 92% (86%-98%), respectively, in the motivational interviewing group and 78% (32%-97%), 91% (28%-98%), and 93% (57%-100%), respectively, in the standard education group. None of the differences were statistically significant. Interviewer proficiency was good, and the protocol could be successfully executed in the given time frame. Footwear adherence at home increases 1 week after motivational interviewing to clinically relevant but not statistically significant levels (ie, 80%) but then returns over time to baseline levels. Away from home, adherence is already sufficient at baseline and remains so over time. The use of motivational interviewing seems feasible for the given purpose and patient group. These findings provide input to larger trials and provisionally suggest that additional or adjunctive therapy may be needed to better preserve adherence.

Regulations for the Prescription of Footwear as Medical Device

Regulations for the Prescription of Footwear as Medical Device

Medical-grade footwear: the impact of fit and comfort

BackgroundPressure-related skin lesions on the digits are a significant cause of discomfort. Most foot pain related to ill-fitting shoes occurs in the forefoot and digital areas. Pain has been associated with poor shoe fit, reduced toe box volume, as well as contour and shape of the shoe Off-the-shelf medical-grade footwear is designed as an intervention for chronic lesions on the digits. These shoes are designed with a flexible neoprene fabric upper that is thought to reduce pressure on the forefoot and reduce discomfort associated with ill-fitting shoes. The aim of this study was to investigate the effect of an off-the-shelf, medical-grade shoe on dorsal digital pressure and perceived comfort when compared to participant’s own preferred shoe.MethodsThirty participants (18 females, 12 males) scored their perceived comfort whilst wearing each footwear style using a visual analog comfort scale. Dorsal digital and interdigital pressures were measured in using the WalkinSense® in-shoe pressure system. Sensors were placed on predetermined anatomical landmarks on the digits. Participants were randomly assigned the test shoe and their own shoe. Once wearing the shoe, the participants walked across a 6 m walkway and pressure data from each sensor was collected and processed to obtain peak pressure, time to peak pressure and contact time.ResultsParticipants scored the test shoe with higher comfort points than their own footwear. Overall peak pressure, pressure time integral and contact time decreased, whilst the time taken to reach peak pressure increased across all anatomical landmarks whilst wearing the test shoe. Statistically significant changes were observed for all of the measured variables relating to pressure on the medial border of the first metatarsophalangeal joint.ConclusionThe test shoe provided greater comfort and reduced the amount of pressure on the forefoot. The medical-grade footwear therefore, is a viable alternative to custom made prescription footwear and is more suitable than a regular everyday shoe when treating digital lesions associated with pressure.

An exploration of diabetic foot screening procedures data by a multiple correspondence analysis.

AimsGangrene and amputation are among most feared complications of diabetes mellitus. Early detection of patients at high risk for foot ulceration can prevent foot complications. Regular foot screening (medical history, foot examination and classification into risk groups) was introduced at the out-patient diabetes clinic in Ljubljana in November 1996. We aimed to explore the relationships between the observed variables, check the appropriateness of the risk status classification and of the post-screening decisions.MethodsThe data of 11.594 patients, obtained in 18 years, were analysed by multiple correspondence analysis (MCA). Most of the observed variables were categorical.ResultsThe majority of the screened population was free of foot complications. We demonstrated an increasing frequency and severity of foot problems with an increasing age, as well as the association between the loss of protective sensation and the history of foot ulceration, foot deformity and callus formation, the history of foot ulcer or amputation and acute foot ulceration. A new finding was that the location of foot deformity points was closer to female than male gender, indicating the possible role of fashionable high-heel footwear. The appropriateness of therapeutic decisions was confirmed: the points representing absent foot pulses and referral to vascular specialist were close together, as well as points representing foot deformity and special footwear prescription or callus formation and referral to pedicurist.ConclusionsMCA was applied to the data on foot pathology in the population attending the out-patient diabetes clinic. The method proved to be a useful statistical tool for analysing the data of screening procedures.

The effects of shoes on knee pain and medial joint loading in persons with knee osteoarthritis: A systematic review with meta-analysis

The effects of shoes on knee pain and medial joint loading in persons with knee osteoarthritis: A systematic review with meta-analysis

The best way to reduce reulcerations: if you understand biomechanics of the diabetic foot, you can do it.

Foot ulcer recurrence is still an unresolved issue. Although several therapies have been described for preventing foot ulcers, the rates of reulcerations are very high. Footwear and insoles have been recommended as effective therapies that prevent the development of new ulcers; however, the majority of studies have analyzed their effects in terms of reducing peak plantar pressure rather than ulcer relapse. Knowledge of biomechanical considerations is low, in general, in the team approach to diabetic foot because heterogeneous professionals having competence in recurrence prevention are involved. Assessment of biomechanical alterations define a foot type position; examining foot structure and recording plantar pressure could help in appropriate insole and footwear prescription and design. Patient education and compliance should be taken into consideration for better therapy success. When patients suffer from rigid deformities or have undergone an amputation, surgical offloading should be considered as an alternative.

Patterns of mediolateral asymmetry in worn footwear

Background: Debate over footwear design and prescription is currently shaped by two opposing paradigms to which the clinician or researcher subscribes. Human structure is considered either ‘poor’ requiring intervention or ‘well-adapted’. The interventionist paradigm directs research on the effect of changing mediolateral footwear bias either within the shoe design or using inserts. However, the mediolateral condition of shoes worn by individuals has seldom been considered or measured.Objective: To describe a clinical assessment tool to measure outer-, mid- and innersole footwear components and report on patterns of mediolateral heel asymmetry in a sample of commonly used footwear.Main Outcome Measure: Total mediolateral asymmetry that includes the difference between medial and lateral outersole (mm), innersoles (mm) and mid- and innersole stiffness (Asker C).Results: A total of 212 shoes provided by 106 participants were assessed, with average shoe age 11.9 months (SD 11.4) and mean use 4.6 hrs.d−1 (SD 3.9). Shoe drop between 1.0 and 3.0 cm was measured in 87.8% of shoes. Zero or symmetrical wear was observed for 41.5% of shoes while 57.6% of shoes had 1 to 5 mm lateral heel degradation. The most frequent was 1 mm (30.2%) followed by 2 mm (12.3%) and 15.1% had 3 to 5 mm. Only 0.9% (2/212) had 1 mm of medial degradation. Asymmetry of wear was influenced by the reported age of the shoe, and females were likely to have greater lateral wear than men.Conclusions: Lateral heel degradation was the most frequently measured mediolateral asymmetry. Mediolateral asymmetry by design and/or degradation was measured in the outer-, mid- and innersoles. These results may be important for related footwear research on aberrant ankle and knee joint function.

Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration

To assess the perceived usability and use of custom- made footwear in diabetic patients who are at high-risk for foot ulceration, and to elucidate the determinants of usability and use. Survey. A total of 153 patients with diabetes, peripheral neuropathy, prior plantar foot ulceration and newly prescribed custom-made footwear, recruited from 10 Dutch multidisciplinary foot clinics. The Questionnaire of Usability Evaluation was used to assess the patients' perception of weight, appearance, comfort, durability, donning/doffing, stability, benefit and overall appreciation of their prescription footwear (all expressed as visual analogue scores). Data on priorities for usability and footwear use (in h/day) were obtained from patient reports. Multivariate logistic regression analysis was used to assess determinants of usability and use. Median (interquartile range) score for overall appreciation was 8.3 (7.1-9.1). Scores ranged from 6.5 (4.5-8.6) for weight to 9.6 (6.3-9.9) for donning/doffing. Footwear comfort was listed most often (33.3%) as the highest priority. Footwear use was <60% of daytime (where daytime was defined as 16 h out of bed) in 58% of patients. The only significant determinant of footwear use was the perceived benefit of the footwear (p = 0.045). Perceived usability of footwear was mostly positive, although individual scores and priorities varied considerably. Footwear use was low to moderate and dependent only on the perceived benefit of the footwear. Therefore, practitioners should focus on enhancing the patient's ap-preciation of the therapeutic benefit of custom-made footwear.

Adherence to Wearing Prescription Custom-Made Footwear in Patients With Diabetes at High Risk for Plantar Foot Ulceration

OBJECTIVEPrescription custom-made footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Particularly, the high prevalence of recurrent foot ulcers focuses the attention on adherence, for which objective data are nonexisting. We objectively assessed adherence in patients with high risk of ulcer recurrence and evaluated what determines adherence.RESEARCH DESIGN AND METHODSIn 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer, and custom-made footwear, footwear use was measured during 7 consecutive days using a shoe-worn, temperature-based monitor. Daily step count was measured simultaneously using an ankle-worn activity monitor. Patients logged time away from home. Adherence was calculated as the percentage of steps that prescription footwear was worn. Determinants of adherence were evaluated in multivariate linear regression analysis.RESULTSMean ± SD adherence was 71 ± 25%. Adherence at home was 61 ± 32%, over 3,959 ± 2,594 steps, and away from home 87 ± 26%, over 2,604 ± 2,507 steps. In 35 patients with low adherence (<60%), adherence at home was 28 ± 24%. Lower BMI, more severe foot deformity, and more appealing footwear were significantly associated with higher adherence.CONCLUSIONSThe results show that adherence to wearing custom-made footwear is insufficient, particularly at home where patients exhibit their largest walking activity. This low adherence is a major threat for reulceration. These objective findings provide directions for improvement in adherence, which could include prescribing specific off-loading footwear for indoors, and they set a reference for future comparative research on footwear adherence in diabetes.

Do orthopaedic shoes improve local dynamic stability of gait? An observational study in patients with chronic foot and ankle injuries

BackgroundComplex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS:MethodsTwenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed.ResultsOrthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed.ConclusionsFootwear adaptation led to pain relief and to improved foot & ankle proprioception. It is likely that that enhancement allows patients to better control foot placement. As a result, higher dynamic stability has been observed. LDS seems therefore a valuable index that could be used in early evaluation of footwear outcome in clinical settings.