Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation

Michael J. Mueller, Michael J. Strube, Brent T. Allen

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

OBJECTIVE - To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA). RESEARCH DESIGN AND METHODS - Thirty patients with diabetes and TMA participated (mean age 62 ± 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments. RESULTS - All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe. CONCLUSIONS - The full length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.

Original languageEnglish
Pages (from-to)637-641
Number of pages5
JournalDiabetes care
Volume20
Issue number4
DOIs
StatePublished - Apr 1997

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