For many residents, the shoe doesn't fit

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Many people with diabetes wear shoes that may contribute to pressure ulcer formation, according to Dutch investigators. Their simple solution: better-designed footwear that actually offloads pressure.

In a recent study, effective offloading was achieved in 61% of 336 feet in a group of 171 patients with diabetic neuropathy. Just 24% of feet achieved this level of pressure offloading across the entire foot.

In addition, only 62% of 147 previous ulcer locations were successfully offloaded, reports the team from the University of Amsterdam.

“These outcomes suggest that improvement in footwear design is required and should focus most on those deformities that affect pressure in the metatarsal region,” the authors noted in Diabetic Medicine.

This highlights the lack of evidence-based recommendations for prescription and design of custom-made footwear, the authors said.

The investigators recommended the use of in-shoe plantar pressure measurements to guide footwear design.
Nevertheless, they concede that “whether the use of these methods prevents ulceration in the diabetic foot remains to be investigated and is a focus of interest in our own trial.”