Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses
Abstract The aim of this systematic review was to identify the best footwear and insole design features for offloading the plantar surface of the foot to prevent foot ulceration in people with diabetic peripheral neuropathy. We searched multiple databases for published and unpublished studies report...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Endocrinology, Diabetes & Metabolism |
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| Online Access: | https://doi.org/10.1002/edm2.132 |
| _version_ | 1818925507271458816 |
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| author | Richard Collings Jennifer Freeman Jos M. Latour Joanne Paton |
| author_facet | Richard Collings Jennifer Freeman Jos M. Latour Joanne Paton |
| author_sort | Richard Collings |
| collection | DOAJ |
| description | Abstract The aim of this systematic review was to identify the best footwear and insole design features for offloading the plantar surface of the foot to prevent foot ulceration in people with diabetic peripheral neuropathy. We searched multiple databases for published and unpublished studies reporting offloading footwear and insoles for people with diabetic neuropathy and nonulcerated feet. Primary outcome was foot ulcer incidence; other outcome measures considered were any standardized kinetic or kinematic measure indicating loading or offloading the plantar foot. Fifty‐four studies, including randomized controlled studies, cohort studies, case‐series, and a case‐controlled and cross‐sectional study were included. Three meta‐analyses were conducted and random‐effects modelling found peak plantar pressure reduction of arch profile (37 kPa (MD, −37.5; 95% CI, −72.29 to −3.61; P < .03), metatarsal addition (35.96 kPa (MD, −35.96; 95% CI, −57.33 to −14.60; P < .001) and pressure informed design 75.4 kPa (MD, −75.4 kPa; 95% CI, −127.4 to −23.44 kPa; P < .004).The remaining data were presented in a narrative form due to heterogeneity. This review highlights the difficulty in differentiating the effect of different insole and footwear features in offloading the neuropathic diabetic foot. However, arch profiles, metatarsal additions and apertures are effective in reducing plantar pressure. The use of pressure analysis to enhance the effectiveness of the design of footwear and insoles, particularly through modification, is recommended. |
| first_indexed | 2024-12-20T02:42:19Z |
| format | Article |
| id | doaj.art-2d6d8cde1d8048cea46d52ccf5b5fd26 |
| institution | Directory Open Access Journal |
| issn | 2398-9238 |
| language | English |
| last_indexed | 2024-12-20T02:42:19Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism |
| spelling | doaj.art-2d6d8cde1d8048cea46d52ccf5b5fd262022-12-21T19:56:16ZengWileyEndocrinology, Diabetes & Metabolism2398-92382021-01-0141n/an/a10.1002/edm2.132Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analysesRichard Collings0Jennifer Freeman1Jos M. Latour2Joanne Paton3School of Health Professions Faculty of Health: Medicine, Dentistry and Human Sciences University of Plymouth Plymouth UKSchool of Health Professions Faculty of Health: Medicine, Dentistry and Human Sciences University of Plymouth Plymouth UKSchool of Nursing and Midwifery Faculty of Health: Medicine, Dentistry and Human Sciences University of Plymouth Plymouth UKSchool of Health Professions Faculty of Health: Medicine, Dentistry and Human Sciences University of Plymouth Plymouth UKAbstract The aim of this systematic review was to identify the best footwear and insole design features for offloading the plantar surface of the foot to prevent foot ulceration in people with diabetic peripheral neuropathy. We searched multiple databases for published and unpublished studies reporting offloading footwear and insoles for people with diabetic neuropathy and nonulcerated feet. Primary outcome was foot ulcer incidence; other outcome measures considered were any standardized kinetic or kinematic measure indicating loading or offloading the plantar foot. Fifty‐four studies, including randomized controlled studies, cohort studies, case‐series, and a case‐controlled and cross‐sectional study were included. Three meta‐analyses were conducted and random‐effects modelling found peak plantar pressure reduction of arch profile (37 kPa (MD, −37.5; 95% CI, −72.29 to −3.61; P < .03), metatarsal addition (35.96 kPa (MD, −35.96; 95% CI, −57.33 to −14.60; P < .001) and pressure informed design 75.4 kPa (MD, −75.4 kPa; 95% CI, −127.4 to −23.44 kPa; P < .004).The remaining data were presented in a narrative form due to heterogeneity. This review highlights the difficulty in differentiating the effect of different insole and footwear features in offloading the neuropathic diabetic foot. However, arch profiles, metatarsal additions and apertures are effective in reducing plantar pressure. The use of pressure analysis to enhance the effectiveness of the design of footwear and insoles, particularly through modification, is recommended.https://doi.org/10.1002/edm2.132diabetic footfootwearinsolesoffloadingpreventionsystematic review |
| spellingShingle | Richard Collings Jennifer Freeman Jos M. Latour Joanne Paton Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses Endocrinology, Diabetes & Metabolism diabetic foot footwear insoles offloading prevention systematic review |
| title | Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses |
| title_full | Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses |
| title_fullStr | Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses |
| title_full_unstemmed | Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses |
| title_short | Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses |
| title_sort | footwear and insole design features for offloading the diabetic at risk foot a systematic review and meta analyses |
| topic | diabetic foot footwear insoles offloading prevention systematic review |
| url | https://doi.org/10.1002/edm2.132 |
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