title: How effective is orthotic treatment in patients with recurrent diabetic foot ulcers?
abstract: BACKGROUND
  We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear.
  
  
  METHODS
  One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy.
  
  
  RESULTS
  Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%.
  
  
  CONCLUSIONS
  Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities.
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Maria Luz Gonzalez
authors.initials: ML
authors.lastname: Fernandez
authors.forename: Rosario Morales
authors.initials: RM
authors.lastname: Lozano
authors.forename: Maria Ignacia Gonzalez-Quijano
authors.initials: MI
authors.lastname: Diaz
authors.forename: Maximo Antonio Gonzalez
authors.initials: MA
authors.lastname: Jurado
authors.forename: David Martinez
authors.initials: DM
authors.lastname: Hernandez
authors.forename: Juan Vicente Beneit
authors.initials: JV
authors.lastname: Montesinos
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D017719:Diabetic Foot / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011312:Pressure; D011446:Prospective Studies; D012008:Recurrence; D013030:Spain; D016896:Treatment Outcome