Shear-reducing insoles to prevent foot ulceration in high-risk diabetic patients

Lawrence A. Lavery, Javier Lafontaine, Kevin R. Higgins, Dan R. Lanctot, George Constantinides

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a shear-reducing insole compared with a standard insole design to prevent foot ulceration in high-risk patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulceration were randomized into a standard therapy group (n = 150) or a shear-reducing insole group (n = 149). Patients were evaluated for 18 months. Standard therapy group consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. The shear-reducing insole group included a novel insole designed to reduce both pressure and shear on the sole of the foot. Insoles were replaced every 4 months in both groups. The primary clinical outcome was foot ulceration. The authors used Cox proportional hazards regression to evaluate time to ulceration. RESULTS: There were 2 significant factors from the Cox regression model: insole treatment and history of a foot complication. The standard therapy group was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group (hazard ratio, 3.47; 95% confidence interval, 0.96-12.67). CONCLUSIONS: These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.

Original languageEnglish (US)
Pages (from-to)519-524
Number of pages6
JournalAdvances in Skin and Wound Care
Volume25
Issue number11
DOIs
Publication statusPublished - Nov 2012

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Keywords

  • Diabetic foot ulcers
  • High-risk persons with diabetes
  • Shear-reducing insoles

ASJC Scopus subject areas

  • Advanced and Specialized Nursing
  • Dermatology

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