Background

Plantar pressure reduction with the use of cushioning materials play an important role in the clinical management of the diabetic foot. Previous studies in people without diabetes have shown that appropriate selection of the stiffness of such materials can significantly enhance their capacity to reduce pressure. However the significance of optimised cushioning has not been yet assessed for people with diabetic foot syndrome.

Research question: What is the potential benefit of using footwear with optimised cushioning, with regards to plantar pressure reduction, in people with diabetes and peripheral neuropathy?

Methods

Plantar pressure distribution was measured during walking for fifteen people with diabetic foot syndrome in a cohort observational study. The participants were asked to walk in the same type of footwear that was fitted with 3D-printed footbeds. These footbeds were used to change the stiffness of the entire sole-complex of the shoe; from very soft to very stiff. The stiffness that achieved the highest pressure reduction relative to a no-footbed condition was identified as the patient-specific optimum one.

Results

The use of the patient-specific optimum stiffness reduced, on average, peak pressure by 46% (± 14%). Using the same stiffness across all participants reduced pressure reduction by at least nine percentile points (37% ± 17%); a statistically significant difference (paired samples t-test, t(13)= -3.733, p = 0.003, d = 0.997). Pearson correlation analysis also indicated that patient-specific optimum stiffness was significantly correlated with the participants’ body mass index (BMI), with stiffer materials needed for people with higher BMI (rs(14) = 0.609, p = 0.021).

Significance

This study offers the first quantitative evidence in support of optimising cushioning in diabetic footwear as part of standard clinical practice. Further research is needed to develop a clinically applicable method to help professionals working with diabetic feet identify the optimum cushioning stiffness on a patient-specific basis.

中文翻译：

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优化的糖尿病鞋缓冲性能可以显着增强其降低足底压力的能力。

背景

使用缓冲材料降低足底压力在糖尿病足的临床管理中起着重要作用。在没有糖尿病的人以前的研究表明，这种材料的硬度适当选择可以显著提升自己，以减少压力的能力。然而，尚未对糖尿病足综合症患者评估最佳缓冲的重要性。

研究问题：在糖尿病和周围神经病患者中，使用具有最佳缓震效果的鞋类在降低足底压力方面有什么潜在好处？

方法

在一项队列观察研究中，对15名糖尿病足综合征患者的步行过程中的足底压力分布进行了测量。要求参与者穿上装有3D打印鞋床的鞋类。这些鞋垫用于改变鞋子整个鞋底的硬度。从非常柔软到非常僵硬。相对于无鞋垫条件，实现最高压力降低的刚度被确定为针对患者的最佳选择。

结果

使用特定于患者的最佳刚度平均可将峰值压力降低46％（±14％）。在所有参与者中使用相同的刚度可以将压力降低至少降低9个百分点（37％±17％）；差异具有统计学意义（配对样本t检验，t（13）= -3.733，p = 0.003，d = 0.997）。Pearson相关分析还表明，患者特定的最佳僵硬度与参与者的体重指数（BMI）显着相关，而BMI较高的人则需要较硬的材料（rs（14）= 0.609，p = 0.021）。

意义

这项研究提供了第一个定量证据，以支持优化糖尿病鞋的缓冲性，这是标准临床实践的一部分。需要开展进一步的研究来开发一种临床适用的方法，以帮助糖尿病足的专业人士根据患者的具体情况确定最佳的缓冲刚度。