How effective is orthotic treatment in patients with recurrent diabetic foot ulcers?

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 prescrib...

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Bibliographic Details
Published inJournal of the American Podiatric Medical Association Vol. 103; no. 4; p. 281
Main Authors Fernandez, Maria Luz Gonzalez, Lozano, Rosario Morales, Diaz, Maria Ignacia Gonzalez-Quijano, Jurado, Maximo Antonio Gonzalez, Hernandez, David Martinez, Montesinos, Juan Vicente Beneit
Format Journal Article
LanguageEnglish
Published United States 01.07.2013
Subjects
Aged
Diabetes Mellitus - therapy
Diabetic Foot - physiopathology
Diabetic Foot - therapy
Female
Follow-Up Studies
Foot - physiopathology
Humans
Male
Middle Aged
Orthotic Devices
Pressure
Prospective Studies
Recurrence
Spain
Treatment Outcome
Spain
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Summary: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. 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. 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%. 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.
ISSN:1930-8264
DOI:10.7547/1030281