E-Journal

  Diabetic Plantar Pressure and Pain                                                                                  Issue No. 37

Although many patients with diabetes have insensate feet, a large percentage of diabetic patients suffer with foot pain due to peripheral arterial disease (PAD). Can a shoe/orthotic combination alleviate some of this pain? This study attempts to determine the impact of one type of custom orthotic on the pain related to diabetic peripheral arterial disease. Along the way, the study findings point to the importance of foot wear for these patients.

 
Sincerely,
 
Cherri Choate, DPM
Larry Huppin, DPM
Alona Kashanian, DPM
Paul R. Scherer, DPM
Randomized Trial of Custom Orthoses and Footwear on Foot Pain and Plantar Pressure in Diabetic Peripheral Arterial Disease
 
Many patients with diabetes have concomitant PAD and subsequent pain associated with PAD. These patients are usually instructed to walk for exercise, but often do not comply due to pain. Since this population frequently develops chronic pain, intermittent claudication, loss of mobility and function, research to assess treatment for the related foot pain is imperative. The goal of this study was to determine the impact of using custom orthoses on foot pain and plantar pressure in diabetic patients with PAD.
 
METHOD
  • N = 61
  • Presence of diabetes with PAD and weight bearing musculoskeletal pain of greater than 6 months
  • Two groups: custom foot orthoses group and sham insole group
  • Both groups received New Balance W575 athletic footwear
  • Data
    • Pedar-X in shoe system to measure pressure
    • Foot Health Status Questionnaire
    • Other measures: toe-brachial index, average daily steps, disability, patient-perceived comfort 
  • Follow up at 8 weeks
 
RESULTS  
  • Significant decrease in pressure beneath the whole foot, rearfoot and forefoot with custom orthotic group 
  • Both conditions improved foot pain but the difference was not significant
  • Both conditions improved foot function but the difference was not significant 
  • Significant decrease in pain was noted in patients with pre-trial footwear that was non-fixated (slip-on)
Significance of the Article

The study showed that "custom foot orthoses significantly reduced plantar pressure compared with the sham". In both groups, pain and function improved with use of suitable footwear and some form of insole or orthotic. Ironically, although the shoes were not the intended focus of the study, some important findings were described. Both groups experienced decreased pain with using the standardized shoes only. In addition, subjects who had worn slip-on shoes before the study showed significant improvement in pain after wearing the study shoes for 8 weeks.
Significance for Orthotic Therapy

Inclusion of footwear evaluation and modification in conjunction with orthotic use is an important component of treating the diabetic/peripheral arterial disease population to assure an improvement in quality of life, as well as pressure reduction and pain reduction. Selecting a proper stable shoe along with a custom orthosis for treatment of patients with diabetes and PAD can significantly reduce plantar pressure and pain. Note that only one custom orthosis type and one shoe type were tested in this study. Since manufacturing design and materials for shoes and orthotics can vary in characteristics such as shock-absorption, stability and compression, results may differ. It is essential that practitioners pay attention to both shoe and orthotic variables when treating this population.
Reference