title: Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation.
abstract: OBJECTIVE
  To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA).
  
  
  METHODS
  Thirty patients with diabetes and TMA participated (mean age 62 +/- 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments.
  
  
  RESULTS
  All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe.
  
  
  CONCLUSIONS
  The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.
authors.affiliation: Program of Physical Therapy, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
authors.forename: M J
authors.initials: MJ
authors.lastname: Strube
authors.forename: B T
authors.initials: BT
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000704:Analysis of Variance; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D017719:Diabetic Foot / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005684:Gait; D006801:Humans; D008124:Locomotion; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008684:Metatarsus / Q000601:surgery*; D008875:Middle Aged; D011312:Pressure; D012775:Shoes / Q000009:adverse effects; D016138:Walking