Abstract
Foot amputation leading to diabetic foot ulcers recently increased. We examined the effects of tailored footwear therapy on sole pressure, gait and sole calluses in diabetic patients at high risk for diabetic foot ulcers. The subjects studied were 12 patients (23 feet) of Type 2 diabetes with neuropathy. Footwear was tailored for each patient. Sole pressure and its distribution with and without footwear were assessed with a sole cushion type manometer, and an assessment was also made on the gait ability. Effect of continuous use of footwear on sole callosity was further studied. Furthermore, the results were classified into two groups according to the degrees of the improvement from callosity, and then the sole pressure was compared. Maximal sole pressure, and peak pressure of the forefoot and the heel were significantly decreased when footwear was used. The ratio of the peak pressure on forefoot to that on the toe has been significantly increased. Sole pressure distribution malfunction has been improved. Maximal sole pressure localized in the forefoot was reduced with the tailored footwear. There was no significant change in gait ability. Sole calluses recognized in 17 feet of 9 patients all of which were for the forefoot before wearing the footwear have been judged as disappeared from 2 feet, improved with 11 feet, stable with 4 feet and no case of worsening or worsened after continuous tailored footwear therapy for 148.3 ± 50.5 (mean ± SD) days. When the group I of the disappeared and the improved was compared with the group II of the stable and the worsened, maximal sole pressure of the latter group II was significantly higher than that of the former group I, when the tailored footwear was used. This eventually leads to the assumption that the decrease in maximal sole pressure was not enough to cure sole callosity. Our findings suggest that the tailored footwear may prevent development of sole callosity by decreasing peak plantar pressure and by normalizing the distribution of maximal sole pressure. The tailored footwear therapy is thought to have a preventive effect on diabetic foot ulcers.
