Diabetic Footwear

People with diabetic foot disease are commonly prescribed with special footwear or other devices to help prevent or treat a foot ulcer. The main mechanism here is the redistribution of mechanical pressure on the foot so to offload specific high-risk or ulcer regions. The most effective way to offload a plantar foot ulcer is by using a total contact cast or a knee-high walker; ankle-high devices are commonly used for offloading but are less effective. Footwear to help prevent a (recurrent) foot ulcer is often custom-made and consists of pressure relieving elements such as a rocker outsole, custom-made insert, metatarsal pad or bar, and cushioning insole top layer. In-shoe plantar pressure measurement proves to be a valuable tool to improve the pressure-relieving properties of preventative footwear, and when such pressure-improved footwear is adequately worn, a significant number of recurrent foot ulcers can be prevented. Guidelines for what entails improved pressure relief have been developed, but ways to improve footwear adherence are not well known; educational techniques and specific offloading shoes for use indoors may contribute. Offloading is one of the cornerstones of treatment of diabetic foot disease and should always be considered in high-risk patients or those with active plantar foot ulcers.