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

Abstract：

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.

journal_name

Adv Skin Wound Care

journal_title

Advances in skin & wound care

authors

Lavery LA,LaFontaine J,Higgins KR,Lanctot DR,Constantinides G

doi

10.1097/01.ASW.0000422625.17407.93

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

519-24; quiz 525-6

issue

eissn

1527-7941

issn

1538-8654

pii

00129334-201211000-00010

journal_volume

pub_type

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