Article

Forefoot offloading shoes (FOS) are commonly used in clinical practice
for treatment of plantar forefoot ulcers in the diabetic foot.
The aim of this
study was to assess the offloading efficacy of four different FOS models in
comparison with a cast shoe and control shoe. METHODS: In-shoe plantar pressures
were measured during walking in each of the six footwear conditions in 24
neuropathic diabetic patients at high risk for plantar foot ulceration. For each
of six foot regions, peak pressure, pressure-time integral, and force-time
integral were calculated. Load transfer diagrams were developed to assess the
footwear mechanisms of action. Perceived walking comfort was measured using a
visual analogue scale (VAS). All comparisons between conditions were tested at
P<0.05. RESULTS: Peak pressures and pressure-time integrals at the metatarsal
heads and hallux regions were significantly reduced (by 38-58%) in all FOS models
when compared with the control shoe. The FOS also relieved metatarsal head peak
pressure to a significantly larger extent than the cast shoe (approximately 20%).
The load transfer diagrams showed a major transfer of approximately 40% of
forefoot load to the midfoot explaining the offloading efficacy of the FOS.
Perceived walking comfort was significantly lower in the FOS (VAS score 2.7-5.9)
when compared with the control shoe (VAS 8.2) and cast shoe (VAS 6.8).
CONCLUSIONS: The data showed that all FOS models were effective in their primary
goal, relieving forefoot pressure in at-risk neuropathic diabetic patients.
Therefore, these shoes may be effective in offloading and healing plantar
forefoot ulcers, although the low comfort scores should be considered as this may
potentially affect adherence to treatment.

Langue : ANGLAIS