TITLE:
Learning from experience: A simple effective protocol to test footwear prescriptions for the Diabetic foot by using the Pedar system
AUTHORS:
Claudia Giacomozzi, Luigi Uccioli
KEYWORDS:
Diabetic Foot; Ulcer Prevention; Footwear; Instrumental Test; Plantar Pressure; Gait Line
JOURNAL NAME:
Journal of Biomedical Science and Engineering,
Vol.6 No.5A,
May
28,
2013
ABSTRACT:
Adherence of patients to treatment and appropriateness
of prescribed footwear are mandatory for successful prevention of Diabetic
foot ulceration. In a Public Healthcare Service, footwear approval is under
the responsibility of the clinician. In some cases kinetic measurements are
taken inside the shoes to support the clinical decision; however, an overall
agreement is still missing with respect to a simple, reliable and effective
test protocol based on proper threshold values. Authors’ past experiences,
specific needs of the Diabetic outpatient service, and suggestions from
valuable literature led to an instrumental test protocol based on reference
peak pressure (PP) thresholds and gait line (GL) specific for each level of risk.
Permission was obtained for one preliminary validation session at the Authors’
outpatient service, during which 11 patients at high/very high risk of
ulceration were examined—9 for testing new footwear, 2 for monitoring
12-month-old footwear. The protocol was well accepted by patients and operators,
fast and easy to be used. Based on the instrumental, clinical and visual
inspection data; 4 new footwear did not pass the test; 5 passed the test but
integration or minor changes were requested; the 2 old footwear were found no
more effective. As a first positive feedback, after 4 months of wearing the
modified prescriptions none of the patients had developed plantar ulcers or
signs of tissue damage. Successive data processing proved that in all patients
altered PPs and deviated GLs did correlate with alterations of other kinetic
parameters. The protocol, which is proved to be sensitive and valuable for the Diabetic
foot care, may have a general validity; the delivered specific PP thresholds
and reference data, instead, can be reliably used if the test is performed with
a calibrated Pedar Insole System and with the wide Insoles in the range UW-YW
(EU size 36 - 45).