Shear-Reducing Insoles to Prevent Foot Ulceration in High-Risk Diabetic Patients.
Lavery, Lawrence A. DPM, MPH; LaFontaine, Javier DPM, MS; Higgins, Kevin R. DPM; Lanctot, Dan R. BS; Constantinides, George BS
Advances in Skin & Wound Care.
25(11):519-524, November 2012.
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PURPOSE: To enhance the learner's competence with knowledge of the effectiveness of shear-reducing insoles for prevention of foot ulceration in patients with high-risk diabetes.
TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
OBJECTIVES: After participating in this educational activity, the participant should be better able to:
1. Demonstrate knowledge of foot ulceration risk, risk factors, incidence, and prevention.
2. Apply knowledge gained from reviewing this study and a literature review about the use of shear-reducing insoles to patient scenarios.
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.
(C) 2012 Lippincott Williams & Wilkins, Inc.