[Preventing high-risk diabetic foot ulceration by a new method of custom-made shoes in high-risk patients. Prospective study].
BACKGROUND
The efficacy of custom-made shoes to prevent diabetic foot ulcerations is still unsatisfactory and specific conception is lacking.


METHODS
We conducted a prospective study on 32 consecutive patients with diabetic mellitus, sensitive neuropathy and healed minor amputation of the foot. They were following a prevention program (education, medical consultation every month). They were treated by custom-made shoes in order to obtain a tested and effective load-off area (after trying and modifying a temporary footwear according to a simple qualitative test of the plantar pressure).


RESULTS
At 1 year, 9% of patients presented a new foot ulceration and 3% new minor amputations of the foot. The custom-made shoes had very thick multiple layer total-contact soles (mean thickness 25 mm for a forefoot deformity and 40 mm for a mid-foot deformity).


CONCLUSIONS
This new concept of custom-made shoes might be effective in enhancing the prevention of neuropathic ulcerations for high-risk patients. A randomized controlled trial would be needed to establish sound evidence supporting this new approach for therapeutic footwear.
Tazi
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Service de rééducation vasculaire, hôpital Broussais, groupe hospitalier HEGP-Broussais, 96, rue Didot, 75674 Paris cedex 14, France.
Debure
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D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000517:prevention & control* / Q000534:rehabilitation* / Q000601:surgery; D003929:Diabetic Neuropathies / Q000517:prevention & control; D005260:Female; D016523:Foot Ulcer / Q000517:prevention & control* / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D010146:Pain / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012775:Shoes; D014656:Vascular Surgical Procedures