title: Therapeutic footwear: enhanced function in people with diabetes and transmetatarsal amputation.
abstract: OBJECTIVE
  Patients with diabetes mellitus (DM) and a transmetatarsal amputation (TMA) have considerable deficits in function compared with age-matched controls. The purpose of this study was to determine if therapeutic footwear could improve the functional mobility of patients with DM and TMA.
  
  
  METHODS
  Repeated-measures design.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Thirty subjects (10 women, 20 men) with DM and a TMA, with a mean age of 61.7 +/- 4.0 yrs.
  
  
  METHODS
  Six types of footwear evaluating the following components: length of shoe (full-length or short shoe), a rigid rocker-bottom sole, and an ankle-foot-orthosis.
  
  
  METHODS
  Physical Performance Test (PPT), functional reach, and walking speed. Measurements in each footwear condition occurred after a 1-month adjustment period.
  
  
  RESULTS
  Patients wearing full-length custom-made shoes with a total-contact insert, a rigid rocker-bottom sole or a short shoe with a rigid rocker-bottom sole (with or without an ankle-foot-orthosis) had similar and significantly higher scores in the PPT and faster walking speed than when wearing regular shoes with a toe filler (p < .05). The short shoe and the ankle-foot-orthosis, however, generated many patient complaints about cosmesis and restriction at the ankle, respectively. There were no differences in any of the measures of functional reach.
  
  
  CONCLUSIONS
  Although there are individual exceptions, we recommend the full-length shoe, total-contact insert, and a rigid rocker-bottom sole for most patients with DM and a TMA.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
authors.forename: M J
authors.initials: MJ
authors.lastname: Strube
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001696:Biomechanical Phenomena; D003920:Diabetes Mellitus / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D009989:Orthotic Devices / Q000145:classification / Q000592:standards*; D012775:Shoes / Q000145:classification / Q000592:standards*