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An innovative sealed therapeutic shoe to off-load and heal diabetic forefoot ulcers
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics; University Health Care Research Center.ORCID iD: 0000-0002-6410-2474
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Aim: The aim was to investigate the feasibility of using a therapeutic shoe, rendered irremovable,to off-load and heal forefoot ulcers. Non-removable knee-high off-loading devicesare gold standard to treat neuropathic forefoot ulcers. They do however immobilize theankle, affecting joint functioning and daily activities.

Method: Seven men with diabetes type 2 since >10 years, sensory neuropathy and a metatarsalhead ulcer (table 1) were prescribed extra-depth therapeutic roller shoes and custom-madeinsoles adjusted to off-load the ulcer (fig. 1). Off-loading was assessed with anin-shoe plantar pressure system* measuring plantar peak pressures as the participantswalked. The shoe was then sealed with a plastic band and worn day and night like a cast.Adherence was assessed by documenting the status of the seal (intact/broken) whenchanging ulcer dressings.

Results / Discussion: All ulcers healed, with a median time to healing of 8 weeks (range1-23). The median peak pressure on the ulcer was 116 kPa (range 62-192) when walkingwith the shoe. Five of seven participants respected the seal. Complications were secondaryulcer (n=1) and plantar hematoma (n=1). The most common complaint was difficulty todress (n=5).

Sealed therapeutic shoes are an interesting avenue for future research; they include advantagesof non-removable knee-high devices as effective off-loading and high adherence,and overcome disadvantages as mobility restrictions and high costs.

Conclusion: It seems feasible to seal a therapeutic shoe to off-load and heal forefoot ulcers.A randomized controlled trial is underway in which sealed shoes are to be comparedto total contact casting.

Place, publisher, year, edition, pages
2018.
National Category
Orthopaedics Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-69389OAI: oai:DiVA.org:oru-69389DiVA, id: diva2:1254159
Conference
15th Annual Meeting of the Diabetic Foot Study Group (DFSG), Berlin, September 28-30, 2018
Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2018-10-08Bibliographically approved

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Jarl, Gustav

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CiteExportLink to record
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Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
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More styles
Language
  • de-DE
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  • en-US
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  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
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  • asciidoc
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