Thickness makes the difference
Shoes and footbeds can help reduce excessive pressure in people with diabetic foot syndrome. One study investigated the role of the top layer of the footbed.
Custom-made (therapeutic) footwear, as well as foot orthoses, foot supports and shoe modifications, aim to reduce high pressures by redistributing pressure from high-risk areas to lower-risk areas. The Dutch working group led by Sicco Bus has published extensively on footwear for diabetic foot syndrome. In a recent study, they investigated the pressure-relieving effect of overlay soles of various thicknesses and material combinations.
The researchers measured the peak pressure in the footwear of 20 subjects with diabetes and peripheral neuropathy while they walked in their prescribed footwear with eight different material overlays tested in a randomised order. The overlays were 3 mm or 6 mm thick open-cell or closed-cell foam, or a 6 mm thick combination of open-cell and closed-cell foam. Pressure measurements were repeated after one month of use of the top cover. Pressure peaks were determined for each anatomical foot region and for a specific region (e.g. previous ulceration or high barefoot pressure). Walking comfort was rated using a 10-point Likert scale.
The 6 mm thick insole overlays generally relieved the peak pressure more than the 3 mm thick open-cell foam overlays. Only minor differences were observed with the 6 mm thick overlays. After one month of wearing the cushions, variable effects on peak pressure in the shoe were observed, with no significant changes over time. Participant satisfaction was high and did not differ significantly between the overlays. This appears to show that different 6mm thick insole overlays can be used in clinical footwear practice to improve the effectiveness of offloading. Therefore, according to the researchers, different 6 mm thick insole overlays can be used in clinical footwear practice to relieve peak plantar pressure in diabetic patients at high risk of foot ulceration. The choice of the overlay may be determined by availability, durability, hygienic properties, ease of use, cost or sustainability rather than superiority in relief capacity.
Bus, S.A.; Busch-Westbroek, T.E.; Pulles, J.; van Dun, T.; Szabo, G.; Lacorte, D.H.; Luckson, D.; van Netten, J.J.
Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration. Sensors 2024, 24, 5549.
The study is freely available:https://doi.org/10.3390/s24175549
