title: Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration.
abstract: OBJECTIVE
  To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes.
  
  
  METHODS
  Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy, and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure > 200 kPa) were targeted for pressure reduction (goal: > 25% relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications, pressures were measured. In a subgroup of 32 patients, pressures were measured and, if needed, footwear was modified at 3-monthly visits for 1 year. Pressures were compared with those measured in 32 control patients who had no footwear modifications based on pressure analysis.
  
  
  RESULTS
  At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23%, 21% and 15%, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 24-28%, compared with pressures in the control group.
  
  
  CONCLUSIONS
  The offloading capacity of custom-made footwear for high-risk patients can be effectively improved and preserved using in-shoe plantar pressure analysis as guidance tool for footwear modification. This provides a useful approach to obtain better offloading footwear that may reduce the risk for pressure-related diabetic foot ulcers.
authors.affiliation: Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands. r.waaijman@amc.uva.nl
authors.forename: R
authors.initials: R
authors.lastname: Waaijman
authors.forename: M L J
authors.initials: ML
authors.lastname: Arts
authors.forename: R
authors.initials: R
authors.lastname: Haspels
authors.forename: T E
authors.initials: TE
authors.lastname: Busch-Westbroek
authors.forename: F
authors.initials: F
authors.lastname: Nollet
authors.forename: S A
authors.initials: SA
authors.lastname: Bus
mesh_terms: D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009989:Orthotic Devices; D011312:Pressure; D055502:Secondary Prevention; D012775:Shoes; D016896:Treatment Outcome; D016138:Walking