Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration
Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration
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DOI：
10.1111/j.1464-5491.2012.03700.x
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发表时间：
2012-12-01
影响因子：
3.5
通讯作者：
Bus, S. A.
中科院分区：
文献类型：
--
作者：
Waaijman, R.;Arts, M. L. J.;Bus, S. A.
Diabet。【摘要】目的探讨利用鞋内足底压力分析改善和保持糖尿病患者定制鞋履的卸荷性能的价值。方法对117例糖尿病、神经病变和足底溃疡愈合的患者进行了鞋内动态足底压力测量。在85例患者中，通过改变鞋类，将高压峰值位置（峰值压力> 200 kPa）作为减压目标（目标：> 25%缓解或低于200 kPa的绝对水平）。在最多三轮修改的每一轮之后，测量压力。在32名患者的亚组中，测量了压力，如果需要，在1年的时间里，每3个月检查一次鞋子。在压力分析的基础上，比较了32名没有修改鞋类的对照患者的压力。结果在先前溃疡部位和最高、次高压力部位，鞋型改良后的峰值压力分别显著降低23%、21%和15%。随着时间的推移，这些降低的压力保持或进一步降低，与对照组的压力相比，显著降低了2428%。结论将鞋内足底压力分析作为鞋型改造的指导工具，可有效提高和保留高危患者定制鞋的卸荷能力。这提供了一个有用的方法，以获得更好的卸载鞋，可能会降低风险的压力相关的糖尿病足溃疡。
Diabet. Med. 29, 15421549 (2012) Abstract Aims To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes. Methods Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy, and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure > 200 kPa) were targeted for pressure reduction (goal: > 25% relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications, pressures were measured. In a subgroup of 32 patients, pressures were measured and, if needed, footwear was modified at 3-monthly visits for 1 year. Pressures were compared with those measured in 32 control patients who had no footwear modifications based on pressure analysis. Results At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23%, 21% and 15%, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 2428%, compared with pressures in the control group. Conclusion The offloading capacity of custom-made footwear for high-risk patients can be effectively improved and preserved using in-shoe plantar pressure analysis as guidance tool for footwear modification. This provides a useful approach to obtain better offloading footwear that may reduce the risk for pressure-related diabetic foot ulcers.