title: The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy.
abstract: BACKGROUND
  Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.
  
  
  METHODS
  In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support).
  
  
  RESULTS
  Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions.
  
  
  CONCLUSIONS
  These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.
authors.affiliation: Department of Physical Medicine & Rehabilitation, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 407, Taiwan, Republic of China.
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Lin
authors.affiliation: Department of Physical Medicine & Rehabilitation, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 407, Taiwan, Republic of China.
authors.forename: Huey-Min
authors.initials: HM
authors.lastname: Sheen
authors.affiliation: Department of Physical Medicine & Rehabilitation, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 407, Taiwan, Republic of China.
authors.forename: Chin-Teng
authors.initials: CT
authors.lastname: Chung
authors.affiliation: Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan, Republic of China.
authors.forename: Sai-Wei
authors.initials: SW
authors.lastname: Yang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 407, Taiwan, Republic of China.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.affiliation: School and Graduate Institute of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan, Republic of China.
authors.forename: Hong-Ji
authors.initials: HJ
authors.lastname: Luo
authors.affiliation: Graduate School of Physical Education, National Taiwan University of Physical Education and Sport, No. 16, Sec. 1, Shuang-Shih Rd, Taichung 404, Taiwan, Republic of China.
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Department of Physical Medicine & Rehabilitation, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 407, Taiwan, Republic of China.
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Chan
authors.affiliation: Department of Physical Therapy, Fooyin University, 1 Jinxue Rd., Daliao Dist, Kaohsiung 83102, Taiwan, Republic of China.
authors.forename: Hsu-Sheng
authors.initials: HS
authors.lastname: Shih
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 407, Taiwan, Republic of China.|College of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan, Republic of China.|Institute of Medical Technology, National Chung-Hsing University, 250 Kuo Kuang Rd, Taichung 402, Taiwan, Republic of China.
authors.forename: Wayne Huey-Herng
authors.initials: WH
authors.lastname: Sheu
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