title: Reduction of plantar pressures in leprosy patients by using custom made shoes and total contact insoles.
abstract: OBJECTIVE
  The purpose of this study was to observe whether our custom made shoes and total contact insoles can effectively increase the plantar contact areas and reduce peak pressures in patients with leprosy.
  
  
  METHODS
  In the rehabilitation laboratory of a tertiary medical center. Six male and two female leprosy patients were recruited in this study. In this study, parameters related to foot pressures were compared between these patients wearing commercial available soft-lining kung-fu shoes and our custom made shoes with total contact insoles. The custom made shoes were made with larger toe box and were able to accommodate both the foot and the insoles. Custom made total contact insoles were made with the subtalar joints under neutral and non-weight-bearing positions. The insole force measurement system of Novel Pedar-X (Novel, Munich, Germany) was used to measure the plantar forces. The parameters of contact area (cm(2)), peak plantar pressures (kPa), contact time (s), and pressure time integral (kPa s) were measured.
  
  
  RESULTS
  There were significant contact area increases in the right and left foot heel areas, left medial arch, and second to fifth toes after wearing the custom made shoes and insoles. There were significant decreases in peak plantar pressures in bilateral heels, left lateral midfoot, bilateral second to fourth metatarsal areas, and left fifth metatarsal head after wearing the custom made shoes and insoles (p<0.05).
  
  
  CONCLUSIONS
  Plantar ulceration is a common serious disability in leprosy patients. As a result, footwear and measures able to reduce plantar pressures may be beneficial in preventing plantar ulcers from occurring in these patients. Our custom made shoes and total contact insoles were proven to be effective in increasing contact areas and decreasing peak pressures in plantar surfaces, and may therefore be a feasible treatment option in preventing leprosy patients from developing plantar ulcers.
authors: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan.
authors: Simon Fuk-Tan
authors: SF
authors: Tang
authors: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan.
authors: Carl P C
authors: CP
authors: Chen
authors: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: Shih-Cherng
authors: SC
authors: Lin
authors: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: Chih-Kuan
authors: CK
authors: Wu
authors: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: Chih-Kuang
authors: CK
authors: Chen
authors: Department of Physical Medicine and Rehabilitation, Taoyuan Hospital, Ministry of Health and Welfare. Electronic address: cspcij@ms52.hinet.net.
authors: Shun-Ping
authors: SP
authors: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005528:Foot; D061826:Foot Orthoses; D016523:Foot Ulcer / Q000517:prevention & control*; D006801:Humans; D015440:Leprosy, Lepromatous / Q000534:rehabilitation*; D008297:Male; D011312:Pressure; D012775:Shoes; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Custom made total contact insoles; Leprosy; Peak pressure; Ulcers