Effect of customised insoles on vertical plantar pressures in sites of previous neuropathic ulceration in the diabetic foot
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It is well documented that people with peripheral neuropathy resulting from diabetes mellitus are at an increased risk of developing foot ulceration. Decreased sensation, in combination with high underfoot pressures, has been identified as a prime aetiological factor in the cause of plantar neuropathic ulceration. Foot orthoses are amongst the therapeutic modalities utilized by clinicians in an attempt to decrease elevated plantar pressures from focal areas of actual or potential ulceration. To investigate the effect that custom-made orthoses have on vertical plantar pressures in previously ulcerated sites, eight participants with diabetes mellitus and a history of neuropathic ulceration (four with unilateral ulceration and four with bilateral ulceration), that had been healed for a duration of two months or longer, were assessed. All participants were routinely wearing customized orthoses that had been issued after ulcer healing, with the aim of decreasing plantar pressures and maintaining the healed state. Measurements were taken with and without the customized insole using the F-Scan in-shoe pressure measurement system. Peak vertical pressure, duration of loading, rate of loading, pressure/time integral and total contact surface area were the parameters compared in the insole versus no insole situation. Data were analysed with two-tailed paired t-tests. Reductions in peak vertical pressure (P<0.01), the pressure/time integral (P<0.05) and increased total contact surface area (P<0.01) were statistically significant for the insole versus no insole comparison. Interestingly, there were large differences between participants in the amount of pressure reduction that occurred with the insole, which in some instances was negligible. The findings of this study continue to raise questions regarding the multifactorial aetiology of neuropathic ulceration and the role of vertical plantar pressures in this process. (C) 2000 Harcourt Publishers Ltd.