Prevent and treat.

Inappropriate footwear is the cause of many foot ulcers – causes 20-80% of ulcers.

Provide protection from damage and reduce plantar pressures.
Generally reduce plantar pressure by about 30%

Play vital role in treatment and prevention (especially recurrences).

Effect of footwear is due to:
protection of the foot from trauma (upper)
redistributes pressures (insole, outersole)
restriction of motion (outersole)

Barriers to use of appropriate footwear:
reimbursement procedures
fashionable vs protective
many patients avoid wearing them

Research on use of footwear:
• Edmonds et al (1986) reported a 26% reulceration rate in the group wearing therapeutic footwear versus 83% in their own footwear.
• Uccioli et al (1995) showed a 28% relapse in the therapeutic footwear group versus 58% in the control group
• Reiber et al (2002), in the biggest study, where not able to demonstrate a reduction in the reulceration rate in two groups using therapeutic footwear (with different types of inserts) compared to a control group. Reulceration rates were 15%, 14% and 17% in the three groups. They suggested that careful attention to footcare may be more important than therapeutic footwear in reducing the reulceration rate. These authors made five conclusions from their study:
While it is a popular belief that therapeutic shoes and inserts should be dispensed freely to all patients with diabetes, this study did not provide evidence to support this
customised cork inserts offered no benefit over prefabricated polyurethane inserts, and control patients wearing their usual footwear fared as well as intervention patients in therapeutic shoes
this study suggests that careful attention to foot care by physicians may be more important than therapeutic footwear, but the study does no negate the possibility that special footwear is beneficial in persons with diabetes who either do not receive such close attention to footcare or have severe foot deformity
4strategies to reduce external trauma unrelated to shoes appear to be indicated, including safe hose slippers
The highest risk patients, those who have foot insensitivity, are also the most vulnerable to complications. Limited health care resources might be better used to develop a comprehensive approach to care for these individuals

Rocker sole:
Allows plantar pressures to be reduced by up to 50%

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