Learning from experience: A simple effective protocol to test diabetic footwear prescriptions?

This manuscript from:

J. Biomedical Science and Engineering, 2013, 6, 45-57 JBiSE doi:10.4236/jbise.2013.65A008 Published Online May 2013 (http://www.scirp.org/journal/jbise/)

Claudia Giacomozzi1, Luigi Uccioli2
1Department of Technology and Health, Italian National Institute of Health, Rome, Italy 2Department of Internal Medicine, Tor Vergata University Hospital, Rome, Italy

Adherence of patients to treatment and appropriate- ness of prescribed footwear are mandatory for successful prevention of Diabetic foot ulceration. In a Public Healthcare Service, footwear approval is un- der the responsibility of the clinician. In some cases kinetic measurements are taken inside the shoes to support the clinical decision; however, an overall agreement is still missing with respect to a simple, reliable and effective test protocol based on proper threshold values. Authors’ past experiences, specific needs of the Diabetic outpatient service, and sugges- tions from valuable literature led to an instrumental test protocol based on reference peak pressure (PP) thresholds and gait line (GL) specific for each level of risk. Permission was obtained for one preliminary validation session at the Authors’ outpatient service, during which 11 patients at high/very high risk of ulceration were examined—9 for testing new foot- wear, 2 for monitoring 12-month-old footwear. The protocol was well accepted by patients and operators, fast and easy to be used. Based on the instrumental, clinical and visual inspection data; 4 new footwear did not pass the test; 5 passed the test but integration or minor changes were requested; the 2 old footwear were found no more effective. As a first positive feed- back, after 4 months of wearing the modified pre- scriptions none of the patients had developed plantar ulcers or signs of tissue damage. Successive data processing proved that in all patients altered PPs and de- viated GLs did correlate with alterations of other ki- netic parameters. The protocol, which is proved to be sensitive and valuable for the Diabetic foot care, may have a general validity; the delivered specific PP
thresholds and reference data, instead, can be reliably used if the test is performed with a calibrated Pedar Insole System and with the wide Insoles in the range UW-YW (EU size 36 – 45). 

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