Footwear and insole prescription for people with diabetes and neuropathy who are at high risk of plantar forefoot ulceration

Sayed Ahmed

doi:10.25918/thesis.320

This PhD thesis delves into the critical realm of diabetes-related foot complications, a global catalyst for hospitalisations and lower limb amputations. Footwear emerges as a pivotal tool in managing diabetic foot, specifically in averting plantar forefoot ulceration. However, the complexity of footwear needs intensifies with the escalating risk of foot ulceration. Pedorthists contribute significantly to crafting this specialised footwear within a multidisciplinary care framework. Despite its centrality, footwear prescription remains more of an art form than an evidence-based practice, with limited exploration of design parameters influencing clinical outcomes and patient satisfaction. The thesis endeavors to establish a robust set of design principles for footwear and insole design, specifically targeting the prevention of neuropathic plantar forefoot ulcers in individuals with diabetes. To achieve this overarching aim, three primary objectives guide the research: Literature Review: Conduct a comprehensive examination and summary of existing literature on the efficacy of footwear and insoles in reducing peak plantar pressures and preventing diabetes-related neuropathic forefoot ulceration. Population Exploration: Investigate the demographic of patients utilising pedorthic services, along with an exploration of contemporary pedorthic practices in footwear prescription and manufacture. Footwear Examination: Scrutinise the influence of footwear features on plantar pressure, patient satisfaction, and adherence through a series of N-of-1 trials evaluating design parameters impacting offloading of the plantar forefoot in individuals with diabetes and neuropathy. Results from the systematic literature review highlight the efficacy of footwear and custom insoles with specific design features in reducing plantar pressures and potentially averting ulcers. However, existing studies vary in methodological quality, and evidence related to prescription and adherence remains limited. The clinical audit underscores the intricate nature of the patient population, revealing variations in social issues, funding models, cultural needs, and personal preferences influencing outcomes. Survey results illuminate diverse prescribing habits and strategies employed by pedorthists to tackle patient adherence challenges. N-of-1 trials underscore the success of footwear and insole prescription when considering patient-specific factors, emphasising the importance of satisfaction and adherence. Key insights include the person-specific nature of plantar pressure cutoffs, the positive impact of walking aids, and the significance of a culturally sensitive approach and social supports in enhancing adherence. In conclusion, the developed principles advocate a multidisciplinary, person-centric approach, emphasising comprehensive limb assessment, understanding individual needs, and continuous education and follow-up. This valuable framework extends beyond diabetes care, offering insights for personalised medical device design in diverse healthcare domains, with a call for further research to enhance clinical and adherence-related outcomes.

Footwear and insole prescription for people with diabetes and neuropathy who are at high risk of plantar forefoot ulceration

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Footwear and insole prescription for people with diabetes and neuropathy who are at high risk of plantar forefoot ulceration

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