The Effectiveness of Orthotic Treatment in Patients with Recurrent Diabetic Foot Ulcers



This study was conducted to determine whether the re-ulceration rate in patients with diabetic neuropathic foot ulcers could be addressed with a personalised orthopodologic regimen based on the plantar pressures and biomechanics of the individual foot.

Neuropathy was diagnosed by examining ten sites on the foot using a Semmes-Weinstein monofilament 5.07/10 g and a neurotensiometer.

In each foot, the factors assessed were joint mobility, goniometry and biomechanics.

Plantar pressures while walking were recorded, using a 2m-long Footscan 7.x gait interface system at a recording speed of 500 photograms per second.

A radiophotopodogram was prepared for each foot by obtaining an imprint of the sole of the foot on radiographic paper, and superimposing this footprint on a plantar radiograph to visualise bone prominences corresponding to the zones of highest pressure.

A mould was then prepared using the impression of the sole made in a foam impression box.

Personalised footwear with insoles were prescribed according to the length and width of the foot and the given foot abnormality to eliminate pressures and to reduce the risk of recurrent ulcers.
In patients re-ulcerating during orthotic treatment, a significant reduction in mean peak plantar pressures was observed.

No significant differences emerged between mean peak plantar impulses, with and without orthotic treatment.

Hence, a personalised biomechanical treatment targeted at diminishing plantar pressures, can reduce the risk of foot ulceration in high-risk patients with neuropathic ulcers.

References:

  1. Maria Luz Gonzalez Fernandez, Rosario Morales Lozano, Maria Ignacia Gonzalez-Quijano Diaz, Maximo Antonio Gonzalez Jurado, David Martinez Hernandez, Juan Vicente Beneit Montesinos (2013) How Effective Is Orthotic Treatment in Patients with Recurrent Diabetic Foot Ulcers? Journal of the American Podiatric Medical Association: July/August 2013, Vol. 103, No. 4, pp. 281-290

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