title: Efficacy of multilayered hosiery in reducing in-shoe plantar foot pressure in high-risk patients with diabetes.
abstract: OBJECTIVE
  High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.
  
  
  METHODS
  Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40-80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas.
  
  
  RESULTS
  The results showed a significant increase in maximum foot contact area of 11 cm2 (95% CI 7-11) when subjects wore the PFC socks (P < 0.01). This was accompanied by 5.4 kPa (3.5-7.3) or 9% reduction in total foot pressure (P < 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.
  
  
  CONCLUSIONS
  These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients.
authors.affiliation: Diabetes Foot Clinic, Disablement Services Centre, Withington Hospital, Cavendish Road, Manchester M20 1LB, UK. adam.p.garrow@manchester.ac.uk
authors.forename: Adam P
authors.initials: AP
authors.lastname: Garrow
authors.forename: Carine H M
authors.initials: CH
authors.lastname: van Schie
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003020:Clothing; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005528:Foot / Q000503:physiopathology; D005545:Forefoot, Human / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D010465:Perception; D011312:Pressure; D012307:Risk Factors; D012684:Sensory Thresholds; D012775:Shoes; D014732:Vibration