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Meta-Analysis
. 2020 Apr 11;4(1):e00132.
doi: 10.1002/edm2.132. eCollection 2021 Jan.

Footwear and insole design features for offloading the diabetic at risk foot-A systematic review and meta-analyses

Richard Collings  1   2 , Jennifer Freeman  1 , Jos M Latour  3 , Joanne Paton  1
Affiliations
Meta-Analysis

Footwear and insole design features for offloading the diabetic at risk foot-A systematic review and meta-analyses

Richard Collings et al. Endocrinol Diabetes Metab. .

Abstract

The aim of this systematic review was to identify the best footwear and insole design features for offloading the plantar surface of the foot to prevent foot ulceration in people with diabetic peripheral neuropathy. We searched multiple databases for published and unpublished studies reporting offloading footwear and insoles for people with diabetic neuropathy and nonulcerated feet. Primary outcome was foot ulcer incidence; other outcome measures considered were any standardized kinetic or kinematic measure indicating loading or offloading the plantar foot. Fifty-four studies, including randomized controlled studies, cohort studies, case-series, and a case-controlled and cross-sectional study were included. Three meta-analyses were conducted and random-effects modelling found peak plantar pressure reduction of arch profile (37 kPa (MD, -37.5; 95% CI, -72.29 to -3.61; P < .03), metatarsal addition (35.96 kPa (MD, -35.96; 95% CI, -57.33 to -14.60; P < .001) and pressure informed design 75.4 kPa (MD, -75.4 kPa; 95% CI, -127.4 to -23.44 kPa; P < .004).The remaining data were presented in a narrative form due to heterogeneity. This review highlights the difficulty in differentiating the effect of different insole and footwear features in offloading the neuropathic diabetic foot. However, arch profiles, metatarsal additions and apertures are effective in reducing plantar pressure. The use of pressure analysis to enhance the effectiveness of the design of footwear and insoles, particularly through modification, is recommended.

Keywords: diabetic foot; footwear; insoles; offloading; prevention; systematic review.

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Conflict of interest statement

Richard Collings is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Fellowship for this research project. This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Figures

Figure 1
Figure 1
Flow diagram of study selection
Figure 2
Figure 2
Forest plot of peak pressure for arch profile
Figure 3
Figure 3
Forest plot of peak pressure for metatarsal modification
Figure 4
Figure 4
Forest plot of peak pressure for pressure designed
See this image and copyright information in PMC

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