Optimisation of rocker sole footwear for prevention of first plantar ulcer: comparison of group-optimised and individually-selected footwear designs
Tóm tắt
Appropriate footwear for individuals with diabetes but no ulceration history could reduce the risk of first ulceration. However, individuals who deem themselves at low risk are unlikely to seek out bespoke footwear which is personalised. Therefore, our primary aim was to investigate whether group-optimised footwear designs, which could be prefabricated and delivered in a retail setting, could achieve appropriate pressure reduction, or whether footwear selection must be on a patient-by-patient basis. A second aim was to compare responses to footwear design between healthy participants and people with diabetes in order to understand the transferability of previous footwear research, performed in healthy populations. Plantar pressures were recorded from 102 individuals with diabetes, considered at low risk of ulceration. This cohort included 17 individuals with peripheral neuropathy. We also collected data from 66 healthy controls. Each participant walked in 8 rocker shoe designs (4 apex positions × 2 rocker angles). ANOVA analysis was then used to understand the effect of two design features and descriptive statistics used to identify the group-optimised design. Using 200 kPa as a target, this group-optimised design was then compared to the design identified as the best for each participant (using plantar pressure data). Peak plantar pressure increased significantly as apex position was moved distally and rocker angle reduced (p < 0.001). The group-optimised design incorporated an apex at 52% of shoe length, a 20° rocker angle and an apex angle of 95°. With this design 71–81% of peak pressures were below the 200 kPa threshold, both in the full cohort of individuals with diabetes and also in the neuropathic subgroup. Importantly, only small increases (<5%) in this proportion were observed when participants wore footwear which was individually selected. In terms of optimised footwear designs, healthy participants demonstrated the same response as participants with diabetes, despite having lower plantar pressures. This is the first study demonstrating that a group-optimised, generic rocker shoe might perform almost as well as footwear selected on a patient by patient basis in a low risk patient group. This work provides a starting point for clinical evaluation of generic versus personalised pressure reducing footwear.
Tài liệu tham khảo
van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):84–98.
Bus SA, van Netten JJ, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y, Price PE. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):16–24.
Calle-Pascual AL, Duran A, Benedi A, Calvo MI, Charro A, Diaz JA, Calle JR, Gil E, Maranes JP, Cabezas-Cerrato J. A preventative foot care programme for people with diabetes with different stages of neuropathy. Diabetes Res Clin Pract. 2002;57:111–7.
Rizzo L, Tedeschi A, Fallani E, Coppelli A, Vallini V, Iacopi E, Piaggesi A. Custom-made orthesis and shoes in a structured follow-up program reduces the incidence of neuropathic ulcers in high-risk diabetic foot patients. Int J Low Extrem Wounds. 2012;11:59–64.
Pham H, Harkless LB, Armstrong DG, Giurini JM, Harvey C, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration - a prospective multicenter trial. Diabetes Care. 2000;23:606–11.
Veves A, Murray HJ, Young MJ, Boulton AJ. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992;35:660–3.
Bus SA, Waaijman R, Arts M, de Haart M, Busch-Westbroek T, van Baal J, Nollet F. Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial. Diabetes Care. 2013;36:4109–16.
Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, Bakker K, Cavanagh PR. The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008;24:S162–80.
Owings TM, Apelqvist J, Stenstrom A, Becker M, Bus SA, Kalpen A, Ulbrecht JS, Cavanagh PR. Plantar pressures in diabetic patients with foot ulcers which have remained healed. Diabet Med. 2009;26:1141–6.
Waaijman R, Arts ML, Haspels R, Busch-Westbroek TE, Nollet F, Bus SA. Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration. Diabet Med. 2012;29:1542–9.
Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J Am Podiatr Med Assoc. 2010;100:360–8.
Bus SA, Haspels R, Busch-Westbroek TE. Evaluation and optimization of therapeutic footwear for neuropathic diabetic foot patients using in-shoe plantar pressure analysis. Diabetes Care. 2011;34:1595–600.
Hutchins S, Bowker P, Geary N, Richards J. The biomechanics and clinical efficacy of footwear adapted with rocker profiles--evidence in the literature. Foot. 2009;19:165–70.
Healy A, Naemi R, Chockalingam N. The effectiveness of footwear as an intervention to prevent or to reduce biomechanical risk factors associated with diabetic foot ulceration: a systematic review. J Diabetes Complicat. 2013;27:391–400.
van Schie C, Ulbrecht JS, Becker MB, Cavanagh PR. Design criteria for rigid rocker shoes. Foot & Ankle Int. 2000;21:833–44.
Chapman JD, Preece S, Braunstein B, Hohne A, Nester CJ, Brueggemann P, Hutchins S. Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes. Clin Biomech. 2013;28:679–85.
Nawoczenski DA, Birke JA, Coleman WC. Effect of rocker sole design on plantar forefoot pressures. J Am Podiatr Med Assoc. 1988;78:455–60.
Brown D, Wertsch JJ, Harris GF, Klein J, Janisse D. Effect of rocker soles on plantar pressures. Arch Phys Med Rehab. 2004;85:81–6.
Wrobel JS, Najafi B. Diabetic foot biomechanics and gait dysfunction. J Diabetes Sci Technol. 2010;4:833–45.
Paisley A, Abbott C, van Schie C, Boulton A. A comparison of the Neuropen against standard quantitative sensory-threshold measures for assessing peripheral nerve function. Diabet Med. 2002;19:400–5.
Perry JE, Ulbrecht JS, Derr JA, Cavanagh PR. The use of running shoes to reduce plantar pressures in patients who have diabetes. J Bone Joint Surg Am. 1995;77:1819–28.
Cavanagh PR, Ulbrecht JS. Clinical plantar pressure measurement in diabetes: rationale and methodology. Foot. 1994;4:123–35.
Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C, Maciejewski ML, Yu OC, Heagerty PJ, LeMaster J. Effect of therapeutic footwear on foot reulceration in patients with diabetes - a randomized controlled trial. Jama-J Am Med Assoc. 2002;287:2552–8.