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López-Moral M, García-Madrid M, Molines-Barroso RJ, Sanz-Corbalán I, Tardáguila-García A, Lázaro-Martínez JL. Clinical Efficacy of a Contralateral Shoe Lift in Patients with Diabetic Foot Ulcers and Induced Limb-Length Discrepancies: A Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2025; 14:251-259. [PMID: 39447017 DOI: 10.1089/wound.2024.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024] Open
Abstract
Objective: To evaluate the clinical efficacy of combining an offloading device with a contralateral shoe lift to compensate for induced limb-length discrepancies in participants with plantar diabetes-related foot ulcers. Approach: Between March 2021 and December 2023, 42 consecutive patients with active plantar diabetic foot ulcers (DFUs) were randomly assigned (1:1) to the treatment group (limb-length discrepancy compensation with a shoe lift in the therapeutic footwear of the contralateral limb) or a control group that did not receive limb-length discrepancy compensation. Primary outcomes included the 20-week wound-healing rate and wound area reduction. Secondary outcomes included minor amputation, new ulcers in the contralateral limb, perceived comfort, and hip pain. Results: On an intention-to-treat basis, 15 participants in the control and 19 in the treatment group showed ulcer healing (p = 0.0023). In those with >80% adherence to the offloading device, multivariate analysis showed that the shoe lifts improved ulcer healing time. The use of a shoe lift reduced the number of minor amputations and the occurrence of new ulcers in the contralateral limb (p = 0.035; p = 0.033 respectively). Hip pain and perceived comfort improved with the use of shoe lifts (p < 0.001). Innovation: It validates the use of shoe lifts for patients with DFUs, as it is the first largest study of its kind to establish a clear reference standard to guide clinician decision-making. Conclusion: The use of shoe lifts reduced healing time in participants with diabetes and active plantar foot ulcers. Shoe lifts reduce late complications, including new ulcers in the contralateral limb and minor amputations.
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Affiliation(s)
- Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
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Ferreira G, Pedras S, Louro A, Carvalho A, Pereira MG. Portuguese validation of the foot health status Questionnaire in patients with diabetic foot disease. Disabil Rehabil 2025; 47:2426-2435. [PMID: 39180460 DOI: 10.1080/09638288.2024.2392038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE This study aims to adapt and validate the Foot Health Status Questionnaire, developed by Bennett et al., in Portuguese patients with diabetic foot. MATERIALS AND METHODS A cross-sectional study was conducted with 143 patients with diabetic foot. A principal component analysis with oblique rotation and a confirmatory factor analysis using structural equation modeling were performed. RESULTS The Portuguese version of the FHSQ (FHSQ-PT) in patients with diabetic foot remains equal to the original version, although with all factors correlated with each other. All scales presented high internal consistency values (pain: ω = 0.884; function: ω = 0.890; general foot health: ω = 0.910; and footwear: ω = 0.702), except for the footwear scale, although with a minimum acceptable coefficient. The FHSQ-PT scales showed good convergent validity and good discriminant validity. The FHSQ-PT scales were also able to discriminate between male and female patients as well as between patients with an active diabetic foot ulcer from those who did not. CONCLUSIONS The results of the validated FHSQ-PT for Portuguese patients with diabetic foot showed good psychometric properties, being a useful, objective, and small instrument that may be used in clinical practice by health professionals without consuming too much time.
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Affiliation(s)
- Gabriela Ferreira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Susana Pedras
- Psychology for Development Research Center (CIPD), Institute of Psychology and Educational Sciences, University Lusíada, Porto, Portugal
| | - André Louro
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal and INSIGHT - Piaget Research Center For Ecological Human Development, Piaget Institute - ISEIT/Viseu, Viseu, Portugal
| | - André Carvalho
- Centro Hospitalar e Universitário de Santo António, Porto, Portugal
| | - M Graça Pereira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
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Ouattas A, Finco MG, Dehghan Rouzi M, Azarian M, Rojas AZ, Bargas Ochoa M, El-Refaei N, Momin A, Najafi B. The role of therapeutic footwear to increase daily physical activity in older adults with chronic foot pain. Clin Biomech (Bristol, Avon) 2025; 123:106373. [PMID: 39954566 DOI: 10.1016/j.clinbiomech.2024.106373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/23/2024] [Accepted: 10/28/2024] [Indexed: 02/17/2025]
Abstract
BACKGROUND Approximately third of older adults report foot pain that can lead to reduced physical activity. In this study, we examined whether a novel therapeutic shoe that addresses both aesthetics to enhance acceptability and biomechanical features to reduce foot pain, might improve daily physical activity in older adults with mild to moderate foot pain. METHODS In a 12-week crossover randomized controlled trial, older adults with chronic foot pain were randomly assigned to either group AB or BA. Group AB wore therapeutic footwear (OrthoFeet, NY, USA) for six weeks (intervention A) before switching to their own shoes for six weeks (intervention B). Group BA followed the reverse order. Physical activity (daily steps, burned calories, metabolic equivalent of task) was tracked throughout the trial with a smartwatch. Generalized Estimating Equations were used to compare differences in foot pain and physical activity between interventions A and B. FINDINGS Twenty-nine participants (mean age = 67 ± 5 years, 17 % male) completed the study. Compared to baseline, wearing OrthoFeet increased daily steps (p = 0.045; +698 steps/day), burned kilocalories (p = 0.048; +177 kcal/day), and metabolic equivalent of task (p = 0.046; +34 MET.min.wk.-1). INTERPRETATION Findings suggest that the combination of both aesthetic and biomechanical features designed to encourage engagement in activities of daily living and reduce foot pain, respectively, increased daily physical activity among older adults with mild to moderate foot pain.
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Affiliation(s)
- Abderrahman Ouattas
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - M G Finco
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Center for Anatomical Sciences & Department of Physical Therapy, University of North Texas Health Science Center, Ft. Worth, TX, USA
| | - Mohammad Dehghan Rouzi
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Center for Advanced Surgical and Interventional Technology (CASIT), Department of Surgery, Geffen College of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mehrnaz Azarian
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alejandro Zulbaran Rojas
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Miguel Bargas Ochoa
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nesreen El-Refaei
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Anmol Momin
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Ambulatory Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Center for Advanced Surgical and Interventional Technology (CASIT), Department of Surgery, Geffen College of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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Lazzarini PA, van Netten JJ. Best practice offloading treatments for diabetic foot ulcer healing, remission, and better plans for the healing-remission transition. Semin Vasc Surg 2025; 38:110-120. [PMID: 40086918 DOI: 10.1053/j.semvascsurg.2025.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/24/2025] [Accepted: 01/24/2025] [Indexed: 03/16/2025]
Abstract
Diabetes-related foot disease is arguably the world's least known major health problem and causes a disease burden larger than most well-known diseases, such as stroke and breast cancer. This burden is driven by people developing more severe stages of foot disease, such as foot ulcers and infections, and with that worsening quality of life. To reduce this burden, we need treatments that prevent more severe stages of foot disease and improve quality of life. Best practice offloading treatments have been found to be arguably the most effective existing treatments to heal and prevent diabetes-related foot ulcers and infections, but can worsen quality of life. Furthermore, high re-ulceration rates still occur with best practice offloading treatments after healing. This may be because of the gap in guideline recommendations on the transition from ulcer healing to ulcer remission when it comes to offloading treatments. In this paper, we review why we need offloading treatments and what are the best offloading treatments recommended by the latest international guidelines for healing and remission. Further, we propose plans for future best practice offloading treatments for the transition from healing-to-remission to help reduce re-ulceration rates and improve longer-term ulcer remission. These plans could be the catalyst for better transitioning patients from first ulcer presentation through healing and into long-term remission, and in turn delivering better quality of life, and lower diabetes-related foot disease burdens on patients, nations, and the globe in future.
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Affiliation(s)
- Peter A Lazzarini
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
| | - Jaap J van Netten
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Department of Rehabilitation Medicine, Amsterdam Movement Sciences,Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Havey RM, Patwardhan AG, Stuck RM, Keen SA, Muriuki MG. Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy. J Diabetes Sci Technol 2024:19322968241304751. [PMID: 39711522 DOI: 10.1177/19322968241304751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
BACKGROUND Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types. METHODS An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers' wear diaries using confusion matrix predictive analytics. RESULTS Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms (P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature (P = .024), and acceleration algorithms (P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries. CONCLUSIONS Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.
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Affiliation(s)
| | - Avinash G Patwardhan
- Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Loyola University Medical Center, Maywood, IL, USA
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Ababneh A, Parker C, Moosa S, Aljarrah Q, Jarrah S, Lazzarini PA. Adherence to Wearing Therapeutic Footwear Among People at High-Risk of Diabetes-Related Foot Ulcers in Jordan. INT J LOW EXTR WOUND 2024:15347346241307723. [PMID: 39704131 DOI: 10.1177/15347346241307723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
This study aimed to investigate the levels of adherence to wearing therapeutic footwear, and the factors associated, among people at high-risk of diabetes-related foot ulcers (DFUs) in Jordan. This was a secondary analysis of data from a multi-centre cross-sectional study of participants at high-risk of DFU in Jordan who had therapeutic footwear. Participants had socio-demographic, health, limb, and psychosocial variables collected, plus self-reported their proportion of adherence time wearing therapeutic footwear on an average day (excluding sleeping time) using a visual analogue scale. Participants were categorized into high (≥60%) or low (<60%) adherence levels, plus users (1%-100% adherence) or non-users (0% adherence) of therapeutic footwear. Of 104 included participants (mean age 58 ± 13 years, 68% males), 65 (62.5%) self-reported low adherence levels and 44 (42.3%) as non-users. No variables were independently associated with low adherence levels (P > .05). Whereas participants with lower self-reported foot care outcome expectation scores were independently associated with non-use of therapeutic footwear (P = .05). Most people at high-risk of DFUs in Jordan self-reported low adherence or total non-use of their therapeutic footwear. Perceived low footcare outcome expectations was the only factor found associated with non-use of therapeutic footwear and further research is needed to explore other potential factors.
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Affiliation(s)
- Anas Ababneh
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
| | - Christina Parker
- Faculty of Health, Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sameh Moosa
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Qusai Aljarrah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Samiha Jarrah
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Peter A Lazzarini
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
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Jan YK, Kelhofer N, Tu T, Mansuri O, Onyemere K, Dave S, Pappu S. Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus. Diagnostics (Basel) 2024; 14:2830. [PMID: 39767191 PMCID: PMC11674805 DOI: 10.3390/diagnostics14242830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 12/12/2024] [Accepted: 12/14/2024] [Indexed: 01/11/2025] Open
Abstract
Microcirculation is an essential system that regulates oxygen and nutrients to cells and tissues in response to various environmental stimuli and pathophysiological conditions. Diabetes mellitus can cause microvascular complications including nephropathy, neuropathy, and retinopathy. The pathogenesis of microvascular dysfunction in diabetes is associated with hyperglycemia and the result of an interplay of various factors. Research studies have demonstrated that functional microvascular dysfunction appears much earlier than structural alterations in vasculature in diabetes. This finding of the progression from microvascular dysfunction to macrovascular disease establishes a foundation for the screening and early diagnosis of diabetes by assessing the microvascular function. This comprehensive review discusses technologies (laser Doppler, transcutaneous oximetry, infrared thermography and near-infrared spectroscopy) with computational methods (linear (time and frequency domains), nonlinear and machine learning approaches) for diagnosing microvascular dysfunction in diabetes. Pathophysiological changes of microvascular dysfunction leading to impaired vasomotion and blood flow oscillations in diabetes are reviewed. Recent findings in managing microvascular dysfunction using lifestyle modifications and force-based modulations are evaluated. A consensus endorsed by the American Diabetes Association has been reached that an effective exercise program would greatly slow down the progression of microvascular dysfunction and its impact on diabetic foot ulcers, muscle fatigue and weakness and peripheral neuropathy. However, it is imperative to determine the dose-response relationship of exercise and microvascular responses in patients with diabetes. Research studies have demonstrated that local vibration and whole-body vibration can improve microcirculation in various pathological conditions, including diabetes. Due to the complex nature of microvascular regulation, various computational methods have been developed to shed light on the influence of diabetes on microvascular dysfunction. This comprehensive review will contribute to the diagnosis and management of microvascular dysfunction in diabetes.
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Affiliation(s)
- Yih-Kuen Jan
- Department of Health and Kinesiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Nicolas Kelhofer
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (N.K.); (T.T.)
| | - Tony Tu
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (N.K.); (T.T.)
| | - Owaise Mansuri
- Department of Endocrinology, Carle Foundation Hospital, Urbana, IL 61801, USA; (O.M.); (K.O.); (S.D.)
| | - Kingsley Onyemere
- Department of Endocrinology, Carle Foundation Hospital, Urbana, IL 61801, USA; (O.M.); (K.O.); (S.D.)
| | - Shruti Dave
- Department of Endocrinology, Carle Foundation Hospital, Urbana, IL 61801, USA; (O.M.); (K.O.); (S.D.)
| | - Suguna Pappu
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL 61801, USA;
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Cheng A, Lanting S, Sadler S, Searle A, Spink M, Chuter V. The relationship between Foot Posture Index and plantar pressure in a community-dwelling adult population with Type 2 diabetes. J Tissue Viability 2024; 33:579-583. [PMID: 39054206 DOI: 10.1016/j.jtv.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/23/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
AIMS To investigate the contribution of foot type to plantar pressures in a community-dwelling adult population with type 2 diabetes. METHODS Foot Posture Index-6 (FPI-6) as a measure of foot type, barefoot plantar pressure (peak pressures and pressure-time integrals), presence of forefoot deformities, peripheral neuropathy, ankle and first metatarsophalangeal joint (MTPJ) dorsiflexion range of motion (ROM), and demographic variables were measured. Standard multiple regression models were used to investigate the independent contribution of FPI-6 on plantar pressure variables at the hallux, forefoot, and rearfoot. RESULTS 122 adults (mean age 70.9 ± 9.3, n = 58 female) with type 2 diabetes were recruited. A lower (more supinated) FPI-6 significantly contributed to an increased forefoot pressure-time integral (β = -0.285, p = 0.04). FPI-6 was not a statistically significant independent predictor of peak pressure at the hallux, forefoot or rearfoot. CONCLUSIONS When screening for at-risk sites of elevated plantar pressure in adults with type 2 diabetes, clinicians should consider performing the FPI-6 along with other clinical measures that have been shown to be associated with increased plantar pressures including first MTPJ dorsiflexion ROM, and presence of digital deformities. Evidence-based treatments to offload these areas should then be considered.
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Affiliation(s)
- Ashleigh Cheng
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Sean Lanting
- Discipline of Podiatry, School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia.
| | - Sean Sadler
- Discipline of Podiatry, School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Angela Searle
- Discipline of Podiatry, School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Martin Spink
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Vivienne Chuter
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia; Discipline of Podiatry, School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
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Choonara YM. Enhancing diabetic foot management: Advocating for independent prescribing rights for podiatrists in South Africa. Foot (Edinb) 2024; 60:102126. [PMID: 39178497 DOI: 10.1016/j.foot.2024.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/24/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
Diabetic foot complications are serious issues resulting from uncontrolled diabetes, primarily affecting the feet. Common complications include diabetic neuropathy, ulcers, PAD, Charcot foot, and gangrene. Preventive measures include controlling blood glucose levels, regular foot inspections, proper foot care, wearing appropriate footwear, and seeking prompt medical attention. A holistic approach to diabetic foot management is crucial due to the complex interplay of physiological, psychological, and environmental factors. Glycaemic control is essential for mitigating neuropathy and vasculopathy, while cardiovascular risk factors like hypertension and dyslipidemia are crucial for preventing complications. In South Africa, podiatrists play a crucial role in diabetic foot care, offering specialized expertise in the assessment, management, and prevention of foot complications associated with diabetes mellitus. They collaborate closely with other healthcare professionals to ensure comprehensive and coordinated care.Pharmacological management is a crucial aspect of podiatric care in the UK, where podiatrists use various medications to treat foot conditions effectively. In South Africa, podiatrists lack prescribing authority, leading to limited treatment options, dependency on referrals, and disparities in access to care. This fragmented approach can compromise patient outcomes, especially in chronic conditions like diabetes. To improve patient outcomes and promote optimal foot condition management, policy reforms, interdisciplinary collaboration, and professional advocacy efforts are needed.Policy recommendations for expanding podiatrist prescribing privileges include legislative reforms, regulatory framework updates, and professional accreditation. Legislative reforms could involve amending existing healthcare laws or introducing new regulations that recognize podiatrists as authorized prescribers. Regulatory framework updates should involve working with regulatory bodies to establish prescribing standards, prescribing limitations, and mechanisms for ongoing oversight and accountability. Professional accreditation should ensure educational programs for podiatrists incorporate training in pharmacology, pharmacotherapy, and prescribing practices to prepare graduates for the expanded scope of practice.Stakeholders in South Africa can improve diabetes management by advocating for policy reforms, professional recognition, and patient empowerment initiatives. By aligning policy, practice, education, research, and advocacy efforts, stakeholders can create a supportive ecosystem that fosters innovation, collaboration, and continuous improvement in diabetic foot care.
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Bus SA, Busch-Westbroek TE, Pulles J, van Dun T, Szabo G, Lacorte DH, Luckson D, van Netten JJ. Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration. SENSORS (BASEL, SWITZERLAND) 2024; 24:5549. [PMID: 39275460 PMCID: PMC11398109 DOI: 10.3390/s24175549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024]
Abstract
Pressure-relieving footwear helps prevent foot ulcers in people with diabetes. The footwear design contributes to this effect and includes the insole top cover. We aimed to assess the offloading effect of materials commonly used as insole top cover. We measured 20 participants with diabetes and peripheral neuropathy for in-shoe peak pressures while walking in their prescribed footwear with the insole covered with eight different materials, tested in randomized order. Top covers were a 3 mm or 6 mm thick open or closed-cell foam or a 6 mm thick combination of open- and closed-cell foams. We re-assessed pressures after one month of using the top cover. Peak pressures were assessed per anatomical foot region and a region of interest (i.e., previous ulceration or high barefoot pressure). Walking comfort was assessed using a 10-point Likert scale. Mean peak pressure at the region of interest varied between 167 (SD:56) and 186 (SD:65) kPa across top covers (p < 0.001) and was significantly higher for the 3 mm thick PPT than for four of the seven 6 mm thick top covers. Across 6 mm thick top covers, only two showed a significant peak pressure difference between them. Over time, peak pressures changed non-significantly from -2.7 to +47.8 kPa across top cover conditions. Comfort ratings were 8.0 to 8.4 across top covers (p = 0.863). The 6 mm thick foams provided more pressure relief than the 3 mm thick foam during walking in high-risk people with diabetes. Between the 6 mm thick foams and over time, only small differences exist. The choice of which 6 mm thick insole top cover to use may be determined more by availability, durability, ease of use, costs, or hygienic properties than by superiority in pressure-relief capacity.
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Affiliation(s)
- Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Program Rehabilitation & Development, Amsterdam Movement Sciences Research Institute, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - Tessa E Busch-Westbroek
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Program Rehabilitation & Development, Amsterdam Movement Sciences Research Institute, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - Jan Pulles
- Livit OttoBock Care, Kabelweg 40, 1060 JA Amsterdam, The Netherlands
| | - Tim van Dun
- Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands
| | - Ghizella Szabo
- Livit OttoBock Care, Kabelweg 40, 1060 JA Amsterdam, The Netherlands
| | - Dario H Lacorte
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Dannick Luckson
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Program Rehabilitation & Development, Amsterdam Movement Sciences Research Institute, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
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Jones AW, Makanjuola A, Bray N, Prior Y, Parker D, Nester C, Tang J, Jiang L. The efficacy of custom-made offloading devices for diabetic foot ulcer prevention: a systematic review. Diabetol Metab Syndr 2024; 16:172. [PMID: 39049069 PMCID: PMC11267867 DOI: 10.1186/s13098-024-01392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Therapeutic offloading devices, including insoles, shoes, and other orthoses, are some of the most commonly used interventions to treat or prevent diabetic foot ulceration. Custom-made offloading devices are increasingly used to offset the development of foot ulcers. However, whether these devices are more effective than prefabricated standard offloading devices is uncertain. Therefore, this systematic review collates and examines evidence on the efficacy of custom-made offloading devices in preventing foot ulcer incidence and recurrence in people diagnosed with diabetes. METHODS Five scientific databases were searched, covering 2011-2023. Initial searches and screening were carried out independently by two researchers. Studies meeting the inclusion criteria were further examined through additional screenings, and critical appraisal. Data relevant to the review aims were extracted and analysed within a narrative synthesis. RESULTS Of the 1,715 articles found in the initial searches, nine papers were found to meet inclusion criteria and were included in the review. The evidence shows that custom-made offloading devices are likely to be more effective for reducing or preventing diabetic foot ulcers than standard offloading devices. However, due to a lack of data it remains uncertain whether custom-made offloading devices are more cost-effective for preventing ulceration compared to standard insoles. Likewise, due to measurement heterogeneity between studies and lack of data, it is unclear whether adherence is higher in users of custom-made offloading devices, and whether such devices deliver significantly greater reductions in peak pressure as compared to standard offloading devices. CONCLUSION Custom-made offloading devices are more effective than standard devices for preventing diabetic foot ulceration, and we recommended their use when feasible; however, there remains uncertainty regarding their cost-effectiveness compared to standard insoles and offloading devices.
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Affiliation(s)
- Aled Wyn Jones
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK
| | - Abraham Makanjuola
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK
- Faculty of Life Sciences and Education, University of South Wales, Cardiff, UK
| | - Nathan Bray
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK.
| | - Yeliz Prior
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Daniel Parker
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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12
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Hazbiu A, Teobaldi I, Sepe M, Federici G, Meloni M, Uccioli L. The Appropriateness of Footwear in Diabetic Patients Observed during a Podiatric Examination: A Prospective Observational Study. J Clin Med 2024; 13:2402. [PMID: 38673674 PMCID: PMC11051551 DOI: 10.3390/jcm13082402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was to evaluate the compliance level in footwear choice based on a patient's own risk. Methods: Forty podiatrists participated from 1 September 2017 to 31 August 2018, providing six-section forms which included personal data, risk classification, footwear characteristics and a knowledge questionnaire. Results: This study included 1507 patients. Those with active ulcers were excluded. A total of 43% of patients belonged to risk class 0, 19% to risk class 1, 19% to risk class 2 and 19% to risk class 3. A total of 58% had foot deformities. Conclusions: Nearly half of patients with a high risk of ulceration had knowledge of their own risk but the majority of them did not follow the recommendations. Only a small percentage (36%) of risk class 3 patients wore footwear suitable for their risk class. There was poor consideration of footwear choice among patients. We highlight critical issues in patient education and compliance with wearing footwear appropriate to their risk class.
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Affiliation(s)
- Anisa Hazbiu
- Ambulatorio CIMAU, Via G. Cesare 82, 66054 Vasto, Italy;
| | | | - Mario Sepe
- Centro Podologico Sepe, Via Alcide De Gasperi 4/D, 80036 Palma Campania, Italy;
| | - Giovanni Federici
- Ospedale San Pietro Fatebenefratelli, Via Cassia 600, 00189 Roma, Italy;
| | - Marco Meloni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy
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13
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Ng GW, Gan KF, Liew H, Ge L, Ang G, Molina J, Sun Y, Prakash PS, Harish KB, Lo ZJ. A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies. INT J LOW EXTR WOUND 2024:15347346241233962. [PMID: 38377963 DOI: 10.1177/15347346241233962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies. METHODS Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies. RESULTS Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts. CONCLUSION Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.
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Affiliation(s)
- Gwyneth Wy Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith F Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lixia Ge
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Gary Ang
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Joseph Molina
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Yan Sun
- National Healthcare Group Health Services and Outcomes Research Unit, Singapore, Singapore
| | - Prajwala S Prakash
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Zhiwen Joseph Lo
- Department of Surgery, Woodlands Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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14
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Vas P, Chockalingam N. Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers - State of the Art. Clin Cosmet Investig Dermatol 2023; 16:3547-3560. [PMID: 38107668 PMCID: PMC10725647 DOI: 10.2147/ccid.s333660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.
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Affiliation(s)
- Prashanth Vas
- Department of Diabetes and Diabetic Foot, King’s College Hospital NHS Foundation Trust, London, UK
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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15
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Lepesis V, Paton J, Rickard A, Latour JM, Marsden J. Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT. J Foot Ankle Res 2023; 16:88. [PMID: 38057930 DOI: 10.1186/s13047-023-00690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs. DESIGN AND METHODS Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance. RESULTS At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%). CONCLUSIONS Combining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk. TRIAL REGISTRATION https://classic. CLINICALTRIALS gov/ct2/show/NCT03195855 .
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Affiliation(s)
- Vasileios Lepesis
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alec Rickard
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jonathan Marsden
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
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Wang Y, Cai Q, Bai J, Ming Y, Qin W. Perceptions of protective shoes and recommendations from patients with diabetic foot ulcers. Glob Health Med 2023; 5:306-310. [PMID: 37908513 PMCID: PMC10615025 DOI: 10.35772/ghm.2023.01029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023]
Abstract
Development of diabetic foot can cause serious harm to a patient's body and pose a heavy burden on family members and society. Protective shoes are of great significance to preventing diabetic foot. The aim of the current study was to understand patients' views and suggestions concerning the selection and promotion of protective shoes for diabetics in order to explore existing obstacles and to provide a reference for improving relevant public health care policies and clinical decision-making for patients with diabetic foot ulcers (DFUs). A total of 10 patients with DFUs were recruited. All participants completed a one-hour semi-structured interview, and results reflected the participants' choice of footwear, the patients' perceptions and acceptance of protective footwear, and factors influencing those processes. The use and promotion of protective shoes in China requires greater support, including improved medical insurance policies, promotion of multidisciplinary cooperation between medicine and industry in clinical practice, and better health education.
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Affiliation(s)
- Yiru Wang
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Qing Cai
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Jiaojiao Bai
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Yue Ming
- Department of Endocrinology, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Wen Qin
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
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17
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Vossen LE, van Netten JJ, Bakker CD, Berendsen HA, Busch-Westbroek TE, Peters EJG, Sabelis LWE, Dijkgraaf MGW, Bus SA. An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:663. [PMID: 37828618 PMCID: PMC10568814 DOI: 10.1186/s13063-023-07635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person's needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes. METHODS In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively. DISCUSSION This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.
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Affiliation(s)
- Lisa E Vossen
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Chantal D Bakker
- Department of Rehabilitation Medicine, Máxima Medisch Centrum Veldhoven, de Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Heleen A Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis Delft, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Edgar J G Peters
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Internal Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Louise W E Sabelis
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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18
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Jongebloed-Westra M, Exterkate SH, van Netten JJ, Kappert KDR, Koffijberg H, Bode C, van Gemert-Pijnen JEWC, Ten Klooster PM. The effectiveness of motivational interviewing on adherence to wearing orthopedic shoes in people with diabetes at low-to-high risk of foot ulceration: A multicenter cluster-randomized controlled trial. Diabetes Res Clin Pract 2023; 204:110903. [PMID: 37704109 DOI: 10.1016/j.diabres.2023.110903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
AIM To evaluate the effectiveness of motivational interviewing (MI) performed by MI-trained podiatrists in improving adherence to wearing orthopedic shoes in comparison to usual care in people with diabetes at low-to-high risk of ulceration. METHODS People with diabetes with loss of protective sensation and/or peripheral artery disease, and with orthopedic shoes prescription were allocated to receive one MI-consultation by a podiatrist randomized to MI training (n = 53) or usual care only (n = 68). Adherence was measured as the percentage of steps taken while wearing orthopedic shoes, determined using an insole temperature microsensor and wrist-worn activity tracker during one week at 3 and 6 months. RESULTS The proportion of participants ≥80 % adherent to wearing their orthopedic shoes was higher in the control group than in the MI-intervention group at 3 months (30.9 % versus 15.1 %; p = 0.044), and not significantly different at 6 months (22.1 % versus 13.2 %; p = 0.210). Average adherence was also higher in the control group than the intervention group at both 3 months (60.9 % versus 50.9 %; p = 0.029) and 6 months (59.9 % versus 49.5 %; p = 0.025). CONCLUSIONS One podiatrist-led MI-consultation in its current form did not result in higher adherence to wearing orthopedic shoes in people with diabetes 3 and 6 months after inclusion. TRIAL REGISTRATION Netherlands Trial Register NL7710 (available on the International Clinical Trials Registry Platform).
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Affiliation(s)
- M Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands.
| | - S H Exterkate
- Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands; Voetmax Orthopedie, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands
| | - J J van Netten
- Amsterdam UMC, Location University of Amsterdam, Department of Rehabilitation, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - K D R Kappert
- Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, PO Box 7600, 7600 SZ Almelo, The Netherlands
| | - H Koffijberg
- Department of Health Technology and Services Research, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - C Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - J E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - P M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, Tech Med Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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20
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Exterkate SH, Jongebloed-Westra M, Ten Klooster PM, Koffijberg H, Bode C, van Gemert-Pijnen JEWC, van Baal JG, van Netten JJ. Objectively assessed long-term wearing patterns and predictors of wearing orthopaedic footwear in people with diabetes at moderate-to-high risk of foot ulceration: a 12 months observational study. J Foot Ankle Res 2023; 16:60. [PMID: 37705016 PMCID: PMC10500813 DOI: 10.1186/s13047-023-00656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Orthopaedic footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Robust data on long-term wearing time of orthopaedic footwear are not available, and needed to gain more insights into wearing patterns and associated factors (i.e. participants' demographic, disease-related characteristics, and footwear usability). We aimed to objectively assess long-term wearing patterns and identify factors associated with wearing orthopaedic footwear in people with diabetes at moderate-to-high risk of ulceration. METHODS People diagnosed with diabetes mellitus type 1 and 2 with loss of protective sensation and/or peripheral artery disease and prescribed with orthopaedic footwear were included and followed for 12 months. The primary outcome was mean daily wearing time, continuously measured using a temperature sensor inside the footwear (Orthotimer®). Adherence to wearing orthopaedic footwear was calculated as percentage of wearing time of a total assumed 16 h out-of-bed daytime, where adherence < 60% was a pre-determined non-adherent threshold. Wearing time patterns were assessed by calculating participants' wearing (in)consistency. One-way analyses of variance tested for wearing time differences between subgroups, weekdays, and weekend days. Factors potentially associated with wearing time were collected by questionnaires and medical files. Univariately associated factors were included in multivariate linear regression analysis. RESULTS Sixty one participants were included (mean (SD) age: 68.0 (7.4) years; females: n = 17; type 2 diabetes mellitus: n = 54). Mean (SD) overall daily wearing time was 8.3 (6.1) hours/day. A total of 40 (66%) participants were non-adherent. Participants with a consistent wearing pattern showed higher daily wearing times than participants with an inconsistent pattern. Mean (SD) wearing times were 12.7 (4.3) vs 3.6 (4.8) hours/day, respectively (P < 0.001). Mean (SD) wearing time was significantly higher (P < 0.010) during weekdays (8.7 (6.0) hours/day) compared to Saturday (8.0 (6.1) hours/day) and Sunday (6.9 (6.2) hours/day). In the multivariate model (R2 = 0.28), "satisfaction with my wear of orthopaedic footwear" was positively associated (P < 0.001) with wearing time. The other seven multivariate model factors (four demographic variables and three footwear usability variables) were not associated with wearing time. CONCLUSIONS Only one out of three people at moderate to high risk of foot ulceration were sufficiently adherent to wearing their orthopaedic footwear. Changing people's wearing behaviour to a more stable pattern seems a potential avenue to improve long-term adherence to wearing orthopaedic footwear. Investigated factors are not associated with daily wearing time. Based on these factors the daily wearing time cannot be estimated in daily practice. TRIAL REGISTRATION Netherlands Trial Register NL7710. Registered: 6 May 2019.
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Affiliation(s)
- Stein H Exterkate
- Research & Development, Voetencentrum Wender, Hengelo, 7555 SK, The Netherlands.
| | - Manon Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Tech Med Centre, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Julia E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Josephus G van Baal
- Research & Development, Voetencentrum Wender, Hengelo, 7555 SK, The Netherlands
- Ziekenhuisgroep Twente (ZGT), ZGT Academy, Hengelo, 7555 DL, The Netherlands
- University of Cardiff, Cardiff, CF10 3AT, UK
| | - Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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21
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Devanand DB, Kedgley AE. Objective Methods of Monitoring Usage of Orthotic Devices for the Extremities: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:7420. [PMID: 37687876 PMCID: PMC10490645 DOI: 10.3390/s23177420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many reasons. When considering the effectiveness of orthoses, there needs to be an objective way to monitor whether participants wear the orthosis as instructed, because if this is not followed, the orthoses will not work as intended. This review aimed to identify, summarise, and compare objective methods used to measure compliance with orthoses applied to the extremities. Databases (Scopus, Web of Science, Embase, CINAHL, and MEDLINE) were searched for eligible studies. Twenty-three studies were accepted in the final review, including five studies that employed upper limb orthoses, two that employed hip orthoses, and fifteen that employed lower limb orthoses. To measure compliance objectively, studies utilised temperature sensors, pressure sensors, accelerometers, a step counter, or a combination of sensors. All sensor types have their own advantages and disadvantages and should be chosen based on study-specific parameters. Sensor-derived monitoring provides quantitative, objective data that are beneficial in both clinical and research settings. The ideal solution to monitoring compliance would consist of both objective and user-reported aspects that, in combination, would provide an all-encompassing picture of the orthotic treatment prescribed.
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Affiliation(s)
| | - Angela E. Kedgley
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK;
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22
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Ababneh A, Edwards H, Lazzarini P, Finlayson K. A qualitative exploration of adherence to wearing removable cast walkers in patients with diabetic foot ulcers. J Wound Care 2023; 32:456-466. [PMID: 37405942 DOI: 10.12968/jowc.2023.32.7.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To explore adherence to wearing removable cast walkers (RCWs) among patients with diabetic foot ulcers (DFUs). METHOD A qualitative study was conducted by interviewing patients with active DFUs and using knee-high RCWs as their offloading treatment. The interviews were undertaken at two diabetic foot clinics in Jordan, using a semi-structured guide. Data were analysed through content analysis by developing main themes and categories. RESULTS Following interviews with 10 patients, two main key themes with a total of six categories were identified: theme 1-reporting of adherence levels was inconsistent, included two categories: i) a belief in achieving optimal adherence, and ii) non-adherence was often reported indoors; and theme 2-adherence was a consequence of multiple psychosocial, physiological and environmental factors, which included four categories: i) specific offloading knowledge or beliefs influenced adherence; ii) severity of foot disease influenced adherence; iii) social support benefitted adherence; and iv) physical features of RCWs (the usability of the offloading device) impacted adherence. CONCLUSION Patients with active DFUs reported inconsistent levels of adherence to wearing RCWs which, after deeper investigation, seemed to be due to participants' misperceptions of the optimal adherence. Adherence to wearing RCWs also seemed to be impacted by multiple psychosocial, physiological and environmental factors.
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Affiliation(s)
- Anas Ababneh
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Helen Edwards
- School of Clinical Sciences, Queensland University of Technology, Australia
| | - Peter Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Australia
| | - Kathleen Finlayson
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Australia
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23
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Hulshof CM, van Netten JJ, Dekker MG, Pijnappels M, Bus SA. In-shoe plantar pressure depends on walking speed and type of weight-bearing activity in people with diabetes at high risk of foot ulceration. Clin Biomech (Bristol, Avon) 2023; 105:105980. [PMID: 37178550 DOI: 10.1016/j.clinbiomech.2023.105980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/16/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND In evaluating therapeutic footwear, in-shoe plantar pressure is usually obtained during mid-gait steps at self-selected walking speed in a laboratory setting. However, this may not accurately represent plantar pressures or indicate the cumulative stress experienced in daily life. We investigated the effects of walking speed and different weight-bearing activities on in-shoe plantar pressure in people with diabetes at high risk of ulceration. METHODS In a cross-sectional study including 30 participants we compared in-shoe plantar pressures between three standardized walking speeds (0.8, 0.6 and 0.4 m/s) and between walking at self-selected speed and eight other weight-bearing activities (3 components of the Timed Up and Go test, accelerating, decelerating, stair ascending and descending, and standing). Mean forefoot regional peak plantar pressure and pressure-time integral were statistically assessed per foot using linear mixed models (α < 0.05) with Holm-Bonferroni correction. FINDINGS With increasing walking speed, peak pressures increased and pressure-time integrals decreased (P ≤ 0.014). Peak pressures during standing, decelerating, stair ascending and Timed Up and Go test were lower (P ≤ 0.001), and with other activities not different to walking at self-selected speed. Pressure-time integrals during stair ascending and descending were higher (P ≤ 0.001), during standing lower (P ≤ 0.009), and with other activities not different to walking at self-selected speed. INTERPRETATION In-shoe plantar pressure depends on walking speed and type of weight-bearing activity. Only measuring pressures to evaluate footwear at self-selected walking speed in a laboratory setting may not accurately represent the stress on the foot in daily life of the high-risk patient; a more comprehensive assessment is suggested.
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Affiliation(s)
- Chantal M Hulshof
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Jaap J van Netten
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Maartje G Dekker
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands; Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, Amsterdam, the Netherlands
| | - Mirjam Pijnappels
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands; Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, Amsterdam, the Netherlands
| | - Sicco A Bus
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, the Netherlands
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24
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Reddie M, Shallal C, Frey D. A Scoping Review of Footwear Worn by People With Diabetes in Low- and Middle-Income Countries: Implications for Ulcer Prevention Programs. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200392. [PMID: 37116930 PMCID: PMC10141434 DOI: 10.9745/ghsp-d-22-00392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/29/2023] [Indexed: 04/30/2023]
Abstract
International guidelines advise people with diabetes to wear close-toed, thick-soled footwear to protect against foot ulceration. However, this type of footwear is incompatible with some of the cultures, climates, and socioeconomic conditions in many low- and middle-income countries (LMICs). This scoping review aims to summarize what is known about footwear used by people with diabetes in LMICs and consider whether international diabetic foot guidelines are practical and actionable in these contexts, given current practices. PubMed, CINAHL, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature, and African Journals Online were searched for articles that documented the footwear used by people with diabetes in LMICs. Twenty-five studies from 13 countries were eligible for inclusion and indicated that a large proportion of people with diabetes wear footwear that is considered inappropriate by current guidance, with sandals and flip-flops being popular choices in a majority of the studies. Reasons given for these choices include poverty, lack of awareness of and provider communication about the importance of footwear selection, comfort, and cultural norms. We recommend that LMIC health care systems relying on international guidelines critically consider whether their recommendations are sensible in their settings. Diabetic foot experts and LMIC-based health care stakeholders should collaborate to design alternative guidelines, strategies, and interventions specifically for LMIC contexts to increase preventative practice feasibility and uptake.
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Affiliation(s)
- Madison Reddie
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher Shallal
- Harvard University-Massachusetts Institute of Technology Health Sciences and Technology, Cambridge, MA, USA
| | - Daniel Frey
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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25
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Collings R, Freeman J, Latour JM, Hosking J, Paton J. Insoles to ease plantar pressure in people with diabetes and peripheral neuropathy: a feasibility randomised controlled trial with an embedded qualitative study. Pilot Feasibility Stud 2023; 9:20. [PMID: 36737812 PMCID: PMC9896776 DOI: 10.1186/s40814-023-01252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Therapeutic footwear and insoles are preventative strategies to reduce elevated plantar pressures associated with diabetic foot ulcer risk. An insole intervention appropriate for chairside delivery optimising plantar foot pressure reduction in people with diabetes has been developed. AIM To explore the feasibility and acceptability of testing an optimised insole compared with an active control insole to reduce plantar pressures for people with diabetic peripheral neuropathy. METHODS A double-blinded multi-centre feasibility RCT with an embedded qualitative study. Participants were randomised to either an optimised insole group (intervention) or a standard cushioned insole group (active control). Participants were assessed at baseline, 3, 6, and 12 months with clinical outcomes of foot ulceration and mean peak plantar pressure (MPPP) reduction. An embedded qualitative study involved semi-structured interviews with 12 study participants and three podiatrists to explore their experiences of the intervention and trial procedures. Data were analysed using descriptive statistics (quantitative data) and thematic analysis (qualitative data). RESULTS Screened were142 patients from which 61 were recruited; 30 participants were randomised to the intervention group and 31 to the active control group. Forty-two participants completed the study. At 12 months, 69% of the patient-reported questionnaires were returned and 68% of the clinical outcomes were collected. There were 17 incidences of foot ulceration occurring in 7/31 of the active control group and 10/30 in the intervention group. Mean difference in MPPP between the intervention and active control groups for all regions-of-interest combined favoured the intervention. Thematic analysis revealed three themes; accepting the study, behaviour and support during study procedures, and impact from study participation. CONCLUSION The results of the feasibility RCT suggest that the optimised insole holds promise as an intervention, and that a full RCT to evaluate the clinical and cost-effectiveness of this intervention is feasible and warranted for people with diabetic peripheral neuropathy. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN16011830 . Registered 9th October 2017.
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Affiliation(s)
- Richard Collings
- grid.439442.c0000 0004 0474 1025Department of Podiatry, Torbay and South Devon NHS Foundation Trust, Torquay, UK ,grid.11201.330000 0001 2219 0747School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jennifer Freeman
- grid.11201.330000 0001 2219 0747School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos M. Latour
- grid.11201.330000 0001 2219 0747School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Joanne Hosking
- grid.11201.330000 0001 2219 0747Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK
| | - Joanne Paton
- grid.11201.330000 0001 2219 0747School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
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Jarl G, Hulshof CM, Busch-Westbroek TE, Bus SA, van Netten JJ. Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use? SENSORS (BASEL, SWITZERLAND) 2023; 23:1648. [PMID: 36772691 PMCID: PMC9919850 DOI: 10.3390/s23031648] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Adherence to prescribed footwear is essential to prevent diabetes-related foot ulcers. The aim was to compare different measures of adherence and wearing time of prescribed footwear with a reference adherence measure, among people with diabetes at high risk of foot ulceration. We followed 53 participants for 7 consecutive days. A temperature sensor measured wearing time of prescribed footwear and a triaxial accelerometer assessed weight-bearing activities. Subjective wearing time was self-reported. Reference adherence measure was proportion of weight-bearing time prescribed footwear was worn. We calculated Spearman's correlation coefficients, kappa coefficients, and areas under the curve (AUC) for the association between the reference measure and other measures of adherence and wearing time. Proportion of daily steps with prescribed footwear worn had a very strong association (r = 0.96, Κ = 0.93; AUC: 0.96-1.00), objective wearing time had a strong association (r = 0.91, Κ = 0.85, AUC: 0.89-0.99), and subjective wearing time had a weak association (r = 0.42, Κ = 0.38, AUC: 0.67-0.81) with the reference measure. Objectively measured proportion of daily steps with prescribed footwear is a valid measure of footwear adherence. Objective wearing time is reasonably valid, and may be used in clinical practice and for long-term measurements. Subjective wearing time is not recommended to be used.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Chantal M. Hulshof
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
| | - Tessa E. Busch-Westbroek
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
| | - Sicco A. Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands
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27
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Malki A, Verkerke GJ, Dekker R, Hijmans JM. Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation: A focus group study. PLoS One 2023; 18:e0280264. [PMID: 36634096 PMCID: PMC9836263 DOI: 10.1371/journal.pone.0280264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Persons with diabetes mellitus (DM) and loss of protective sensation (LOPS) due to peripheral neuropathy do not use their therapeutic footwear (TF) consistently. TF is essential to prevent foot ulceration. In order to improve compliance in using TF, influencing factors need to be identified and analyzed. Persons with a history of foot ulceration may find different factors important compared with persons without ulceration or persons who have never used TF. Therefore, the objective of this study was to determine factors perceived as important for the use of TF by different groups of persons with DM and LOPS. METHOD A qualitative study was performed using focus group discussions. Subjects (n = 24) were divided into 3 focus groups based on disease severity: ulcer history (HoU) versus no ulcer history (no-HoU) and experience with TF (TF) versus no experience (no-TF). For each group of 8 subjects (TF&HoU; TF&no-HoU; no-TF&no-HoU), an online focus group discussion was organized to identify the most important influencing factors. Transcribed data were coded with Atlas.ti. The analysis was performed following the framework approach. RESULTS The factors comfort and fit and stability/balance were ranked in the top 3 of all groups. Usability was ranked in the top 3 of group-TF&noHoU and group-noTF&noHoU. Two other factors, reducing pain and preventing ulceration were ranked in the top 3 of group-TF&noHoU and group-TF&HoU, respectively. CONCLUSION Experience with TF and a HoU influence which factors are perceived as important for TF use. Knowledge of these factors during the development and prescription process of TF may lead to increased compliance. Although the main medical reason for TF prescription is ulcer prevention, only 1 group gave this factor a high ranking. Therefore, next to focusing on influencing factors, person-centered education on the importance of using TF to prevent ulcers is also required.
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Affiliation(s)
- Athra Malki
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
- * E-mail:
| | - Gijsbertus J. Verkerke
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, Overijssel, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
| | - Juha M. Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands
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28
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Ababneh A, Finlayson K, Edwards H, van Netten JJ, Lazzarini PA. Differences in adherence to using removable cast walker treatment during daytime and nighttime weight-bearing activities in people with diabetes-related foot ulcers. Ther Adv Endocrinol Metab 2023; 14:20420188221142457. [PMID: 36643893 PMCID: PMC9837274 DOI: 10.1177/20420188221142457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/13/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Patients' adherence to using knee-high offloading treatment is critical to effective healing of diabetes-related foot ulcers (DFUs). Previous studies have found that patients generally have low adherence to using removable knee-high offloading treatments, yet no study has investigated whether their adherence differs during daytime and nighttime. This study aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment during daytime and nighttime weight-bearing activities in people with DFUs. METHODS This was a secondary analysis of data collected from a multi-centre cross-sectional study investigating adherence to using knee-high RCWs among 57 participants with DFUs. All participants had multiple socio-demographic, physiological and psychosocial factors collected, before having their adherence to using RCWs during weight-bearing activity monitored over a 1-week period using the dual activity monitor method. Adherence data were categorised into daytime (06:00-18:00) and nighttime (18:00-06:00) periods and calculated separately. Multiple linear regression was used to identify factors associated with daytime and nighttime adherence. RESULTS Mean adherence to using RCW during weight-bearing activities in people with DFUs was higher during daytime compared with nighttime [39.9% (SD = 18.9) versus 20.4% (SD = 16.7), p < 0.001]. Factors independently associated with lower adherence during daytime were being male, longer diabetes duration, not having peripheral artery disease (PAD), and higher perceived RCW heaviness. Factors associated with lower adherence during nighttime were higher mean daytime steps, not having retinopathy and having dyslipidaemia. CONCLUSIONS Adherence to using RCWs during weight-bearing activities reduced significantly at nighttime compared with daytime among people with DFUs, and this was associated with different factors. Interventions to improve adherence, in research and clinical practice, should incorporate methods to target daytime or nighttime adherence specifically.
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Affiliation(s)
| | - Kathleen Finlayson
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Rehabilitation & Development Program, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter A. Lazzarini
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia
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Does in-shoe pressure analysis to assess and modify medical grade footwear improve patient adherence and understanding? A mixed methods study. J Foot Ankle Res 2022; 15:94. [PMID: 36564819 PMCID: PMC9789308 DOI: 10.1186/s13047-022-00600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Medical grade footwear (MGF) with demonstrated plantar-pressure reducing effect is recommended to reduce the risk of diabetes-related foot ulceration (DFU). Efficacy of MGF relies on high adherence (≥ 80%). In-shoe pressure analysis (IPA) is used to assess and modify MGF, however, there is limited evidence for the impact on patient adherence and understanding of MGF. The primary aim of this study was to determine if self-reported adherence to MGF usage in patients with previous DFU improved following IPA compared to adherence measured prior. The secondary aim was to determine if patient understanding of MGF improved following in-shoe pressure analysis. METHODS Patients with previous DFU fitted with MGF in the last 12 months were recruited. The first three participants were included in a pilot study to test procedures and questionnaires. MGF was assessed and modified at Week 0 based on findings from IPA using the Pedar system (Novel). Patients completed two questionnaires, one assessing patient adherence to MGF at Week 0 and Week 4, the other assessing patient understanding of MGF before and after IPA at week 0. Patient understanding was measured using a 5-point Likert scale (strongly disagree 1 to strongly agree 5). Patient experience was assessed via a telephone questionnaire administered between Weeks 0-1. RESULTS Fifteen participants were recruited, and all completed the study. Adherence of ≥ 80% to MGF usage inside the home was 13.3% (n = 2) pre-IPA and 20.0% (n = 3) at Week 4. Outside the home, ≥ 80% adherence to MGF was 53.3% (n = 8) pre-IPA, and 80.0% (n = 12) at Week 4. Change in scores for understanding of MGF were small, however, all participants reported that undergoing the intervention was worthwhile and beneficial. CONCLUSIONS Self-reported adherence inside the home demonstrated minimal improvement after 4 weeks, however, adherence of ≥ 80% outside the home increased by 27%, with 80% of all participants reporting high adherence at Week 4. Participants rated their learnings from the experience of IPA as beneficial.
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Keukenkamp R, van Netten JJ, Busch-Westbroek TE, Nollet F, Bus SA. Users' needs and expectations and the design of a new custom-made indoor footwear solution for people with diabetes at risk of foot ulceration. Disabil Rehabil 2022; 44:8493-8500. [PMID: 34846977 DOI: 10.1080/09638288.2021.2003878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess users' needs and expectations regarding custom-made indoor footwear, and to design such footwear with similar biomechanical efficacy and better usability compared to regular custom-made footwear in people with diabetes at risk for foot ulceration. MATERIALS AND METHODS Multidisciplinary systematic design approach. Needs and expectations regarding indoor footwear were evaluated via a questionnaire in 50 high foot ulcer risk people with diabetes using custom-made footwear. We systematically designed indoor footwear, and manufactured this for nine participants. Primary requirement was similar plantar pressure compared to participants' regular custom-made footwear. RESULTS Eighty-two percent of participants expressed a need for custom-made indoor footwear and 66% expected such footwear to increase their adherence. The custom-made indoor footwear had the same bottom construction as participants' regular custom-made footwear, but with softer and more light-weight upper materials. Peak pressures were similar or lower, while qualitative evaluation showed better usability and lower costs for indoor footwear. CONCLUSIONS People with diabetes at risk of foot ulceration expressed a clear need for custom-made indoor footwear, and expected such footwear to increase their adherence. Our indoor footwear design provides adequate pressure relief, with better usability, and can be produced at lower costs compared to regular custom-made footwear.Implications for rehabilitationPeople with diabetes at risk of foot ulceration express a need for special indoor footwear.We developed indoor footwear with similar offloading capacity as regular custom-made footwear.The indoor footwear is lighter in weight, easier to don/doff and lower in costs.At-risk people with diabetes expect this footwear to increase their footwear adherence.
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Affiliation(s)
- Renske Keukenkamp
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap J van Netten
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa E Busch-Westbroek
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sicco A Bus
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Jongebloed-Westra M, Bode C, Bente BE, de Jonge JM, ten Klooster PM, Koffijberg H, Exterkate SH, van Netten JJ, van Gemert-Pijnen JEWC. Attitudes and experiences towards the application of motivational interviewing by podiatrists working with people with diabetes at high-risk of developing foot ulcers: a mixed-methods study. J Foot Ankle Res 2022; 15:62. [PMID: 35986419 PMCID: PMC9388362 DOI: 10.1186/s13047-022-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Podiatrists are key professionals in promoting adequate foot self-care for people with diabetes at high-risk of developing foot ulcers. However, merely informing patients about the advantages of foot self-care is insufficient to realise behavioural change. Motivational interviewing (MI) is a promising person-centred communication style that could help to create a working alliance between healthcare providers and patient to improve foot self-care. This study aims to observe and analyse the application of MI in consultations carried out by MI-trained and non-MI-trained podiatrists with their patients, and explore podiatrists’ attitudes and experiences towards MI.
Methods
Eighteen podiatrists (median age: 28.5 years, 10 female and 8 male) followed a three-day basic training in MI and 4 podiatrists (median age: 38.5 years, 4 female) were not trained in MI. To observe and rate the MI-fidelity in daily clinical practice, audio recordings from the MI-trained and non-MI-trained podiatrists were scored with the Motivational Interviewing Treatment Integrity code. Individual, semi-structed, in-depth interviews were conducted with the MI-trained podiatrists to explore their attitudes towards and experiences with MI. These data sources were triangulated to describe the effect of training podiatrists in MI for their clinical practice.
Results
The MI-trained podiatrists scored significantly higher than the non-MI-trained podiatrists on two of four global MI-related communication skills (empathy, p = 0.008 and change talk, p = 0.008), on one of five core MI-adherent behaviours (affirmation, p = 0.041) and on one of the other behaviour counts (simple reflections, p = 0.008). The podiatrists mainly reported their attitudes and experiences regarding partnership and cultivating change talk, during the interviews. In addition, they also mentioned facilitators and barriers to using MI and indicated whether they experienced MI as having added value.
Conclusions
The MI-trained podiatrists used the principles of MI at a solid beginner proficiency level in their clinical practice in comparison to the non-MI-trained podiatrists, who did not reach this level. This achievement is in accordance with the basic MI-training they received. This multi-method study reveals that podiatrists can be effectively trained in applying MI in daily clinical practice.
Trial registration
Netherlands Trial Register NL7710. Registered: 6 May 2019.
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Rovers FJ, Van Netten JJ, Busch-Westbroek TE, Aan de Stegge WB, Bus SA. Adherence to at-Home Monitoring of Foot Temperatures in People with Diabetes at High Risk of Ulceration. INT J LOW EXTR WOUND 2022:15347346221114565. [PMID: 35840892 DOI: 10.1177/15347346221114565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We aimed to investigate adherence to at-home monitoring of foot temperature and its association with patient-, disease- and behavior-related factors, in people with diabetes at high risk of ulceration. We analyzed 151 participants in the enhanced therapy arm of the DIATEMP trial (all at high diabetes-related foot ulcer risk) who aimed to perform and log foot temperatures daily for 18 months or until ulceration. Adherence was the proportion of measurement days covered (PDC), with being adherent defined as PDC≥70%. If a hotspot was recorded, adherence to subsequently reducing ambulatory activity was assessed. Multivariate logistic regression analysis was performed to investigate associations with adherence. We found ninety-four participants (62.3%) adherent to measuring foot temperatures. This was higher in months 1-3 versus months 4-18: 118 (78.1%) versus 78 (57.4%; P < .001). Of 83 participants with a hotspot, 24 (28.9%) reduced ambulatory activity. Increasing age (P = .021, OR = 1.045) and better self-care (P = .007, OR = 1.513) were positively associated with adherence to measuring foot temperature. In conclusion, in people at high diabetes-related foot ulcer risk, adherence to measuring foot temperature was high in the first months after study commencing, but dropped over time. Adherence to reducing ambulatory activity when a hotspot was found was low over the entire study period.
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Affiliation(s)
- F J Rovers
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - J J Van Netten
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - T E Busch-Westbroek
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - W B Aan de Stegge
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - S A Bus
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
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Racaru S, Bolton Saghdaoui L, Roy Choudhury J, Wells M, Davies AH. Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading. Diabetes Metab Syndr 2022; 16:102493. [PMID: 35468484 DOI: 10.1016/j.dsx.2022.102493] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS To identify measurement methods, proportions of adherent participants, factors affecting adherence, and concordance promoting interventions. METHODS A systematic scoping review was conducted by searching Medline, CINAHL, PubMed, EMBASE, and EMCARE databases. RESULTS Twenty-four trials were identified from 1001 citations. Only 25% of the included studies used objective methods to quantify adherence. The proportion of adherent participants (≥80% of daily steps/time) ranged from 28% to 60%. Psychosocial factors are the most common influencers of adherence. However, interventions for improving compliance are lacking. CONCLUSION There is a need to accurately quantify and optimize adherence to foot offloading in people with diabetes.
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Affiliation(s)
- Simona Racaru
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK; Diabetes Education Centre, 1st Floor, Mint Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| | - Layla Bolton Saghdaoui
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK
| | - Jaya Roy Choudhury
- Section of Vascular Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Mary Wells
- Nursing Directorate, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK
| | - Alun H Davies
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK; Section of Vascular Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
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Zhang L, Yick KL, Li PL, Yip J, Ng SP. Foot deformation analysis with different load-bearing conditions to enhance diabetic footwear designs. PLoS One 2022; 17:e0264233. [PMID: 35320281 PMCID: PMC8942268 DOI: 10.1371/journal.pone.0264233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/06/2022] [Indexed: 01/22/2023] Open
Abstract
In-depth analyses of foot surface measurements upon weight bearing are crucial to understand how the dorsal and plantar surfaces of the foot deform during motion to enhance the fit of footwear, which is particularly important for diabetic patients with stringent fit requirements to redistribute the plantar weight forces. This study analyzes diabetic foot deformations under 3 different weight bearing conditions (no weight bearing, half weight bearing, and 80% weight bearing) by using a novel foot scanning method that enables efficient scanning of the dorsal and plantar surfaces of the foot simultaneously. The feet of 48 patients with diabetes mellitus (DM) are scanned. With increased load on the feet, the width of the forefoot increases by 9.7%-10.4%, height of the midfoot decreases by 15.1%-18.2%, forefoot and midfoot rotate to the medial side by 16.9%-23.9% while the rearfoot rotates to the lateral side by 15.2% simultaneously, and the plantar of the foot increases contact with the floor by 11.4%-23.0%. Gender differences in foot shape are also found between males and females, males have a broader foot than females for the same foot length. Precise anthropometric information of foot changes and deformation therefore enables adequate foot protection, fit and comfort when designing footwear. This research contributes to shoe design considerations that focus on the deformation of the foot under different loads.
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Affiliation(s)
- Liying Zhang
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
| | - Kit-lun Yick
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
- * E-mail:
| | - Pui-ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
| | - Joanne Yip
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Sun-pui Ng
- Hong Kong Community College, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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Keukenkamp R, van Netten JJ, Busch-Westbroek TE, Bus SA. Custom-made footwear designed for indoor use increases short-term and long-term adherence in people with diabetes at high ulcer risk. BMJ Open Diabetes Res Care 2022; 10:10/1/e002593. [PMID: 35131807 PMCID: PMC8823077 DOI: 10.1136/bmjdrc-2021-002593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/07/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To explore changes in footwear adherence following provision of custom-made indoor footwear in people with diabetes at high risk for plantar foot ulceration and in possession of regular custom-made footwear. RESEARCH DESIGN AND METHODS Adherence indoors and outdoors was assessed objectively as percentage of steps custom-made footwear was worn, at baseline (in regular custom-made footwear), and at 1 and 12 months after providing custom-made indoor footwear (in both indoor and regular footwear). Primary group: participants with low (<80%) baseline indoor adherence; secondary group: participants with high (≥80%) baseline indoor adherence. Peak plantar pressures of the indoor footwear were compared with the regular custom-made footwear. Footwear usability was evaluated at 3 months via a questionnaire. At 12 months, ulcer recurrence was assessed through participant/prescriber reporting. RESULTS Of 31 participants, 23 had low baseline indoor adherence (<80%). Overall adherence in this group increased statistically significant from median 65% (IQR: 56%-72%) at baseline to 77% (60%-89%) at 1 month (p=0.002) and 87% (60%-93%) at 12 months (p<0.001). This was due to a significant increase in adherence indoors: baseline: 48% (21%-63%); 1 month: 71% (50%-83%) (p=0.001); and 12 months: 77% (40%-91%) (p<0.001). Mean peak plantar pressures were comparable between the indoor and regular custom-made footwear. Participants were positive about usability. One-year ulcer recurrence rate was 26%. CONCLUSIONS Footwear adherence increased in the short-term and long-term after provision of custom-made indoor footwear in people at high risk of diabetic foot ulceration with low baseline adherence, because they actively wore their newly provided indoor footwear inside their house. Footwear adherence may be helped by using both regular and indoor custom-made footwear in clinical practice; the effect on ulcer recurrence should be investigated in future trials.
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Affiliation(s)
- Renske Keukenkamp
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tessa E Busch-Westbroek
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The Netherlands
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Ababneh A, Finlayson K, Edwards H, Lazzarini PA. Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers. BMJ Open Diabetes Res Care 2022; 10:10/1/e002640. [PMID: 35144940 PMCID: PMC8845212 DOI: 10.1136/bmjdrc-2021-002640] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Adherence to using knee-high offloading treatment is critical for healing diabetes-related foot ulcers (DFUs). However, few studies have investigated patients' adherence to using knee-high offloading treatment. We aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment among patients with DFUs. RESEARCH DESIGN AND METHODS In this multicenter cross-sectional study, we investigated adherence to using knee-high RCWs in 57 participants with DFUs. All participants were clinically examined for multiple sociodemographic, physiological, and psychosocial factors. Each participant's adherence level to using RCWs was then objectively measured using dual activity monitors (attached to the wrist and RCW) over a 1-week period. Multiple linear regression was undertaken to determine those factors independently associated with adherence levels. RESULTS The mean adherence level to using RCWs was 33.6% (SD 16.5) of weight-bearing activity. Factors independently associated with lower adherence levels were being male, longer diabetes duration, not having peripheral artery disease (PAD), and having higher perceived RCW heaviness (p≤0.05). No associations were found with psychosocial factors. CONCLUSIONS Patients with DFUs adhered to using their RCWs on average for only a third of their prescribed weight-bearing treatment duration. Factors linked to lower RCW adherence levels were being male, longer diabetes duration, not having PAD, and perceived heavier RCWs. These findings highlight the importance of using gold standard non-removable knee-high offloading device treatment. Furthermore, these findings suggest, when gold standard devices are containdicated, that these factors be considered when prescribing the second choice RCW offloading treatment to optimise adherence. Regardless, further longitudinal studies are needed to confirm these factors.
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Affiliation(s)
- Anas Ababneh
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kathleen Finlayson
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Queensland, Australia
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Bashir AZ, Dinkel DM, Pipinos II, Johanning JM, Myers SA. Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review. J Manipulative Physiol Ther 2022; 45:114-126. [PMID: 35753880 PMCID: PMC9329246 DOI: 10.1016/j.jmpt.2022.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings. METHODS Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance. RESULTS Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics. CONCLUSIONS Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.
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Affiliation(s)
- Ayisha Z Bashir
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska; Department of Health and Kinesiology, University of Nebraska, Omaha, Nebraska.
| | - Danae M Dinkel
- Department of Health and Kinesiology, University of Nebraska, Omaha, Nebraska
| | - Iraklis I Pipinos
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jason M Johanning
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska; Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska
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Zhang X, Wang H, Du C, Fan X, Cui L, Chen H, Deng F, Tong Q, He M, Yang M, Tan X, Li L, Liang Z, Chen Y, Chen D, Armstrong DG, Deng W. Custom-Molded Offloading Footwear Effectively Prevents Recurrence and Amputation, and Lowers Mortality Rates in High-Risk Diabetic Foot Patients: A Multicenter, Prospective Observational Study. Diabetes Metab Syndr Obes 2022; 15:103-109. [PMID: 35046681 PMCID: PMC8759996 DOI: 10.2147/dmso.s341364] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapy's clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions. METHODS A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy. RESULTS Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up. CONCLUSION Patients' adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.
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Affiliation(s)
- Xi Zhang
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Hongyan Wang
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Xiaoyun Fan
- Department of Endocrinology, Hospital for Occupational Diseases of Chongqing, Chongqing, People’s Republic of China
| | - Long Cui
- Department of Endocrinology, Armed Police Hospital of Chongqing, Chongqing, People’s Republic of China
| | - Heming Chen
- Department of Endocrinology, Ankang Central Hospital, Ankang, Shaanxi, People’s Republic of China
| | - Fang Deng
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, People’s Republic of China
| | - Qiang Tong
- Department of Endocrinology, Chongqing Xinqiao Hospital, Chongqing, People’s Republic of China
| | - Min He
- Department of Endocrinology, The People’s Hospital of Shapingba District, Chongqing, People’s Republic of China
| | - Mei Yang
- Department of Endocrinology, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, People’s Republic of China
| | - Xingrong Tan
- Department of Endocrinology, The 9th People’s Hospital of Chongqing, Chongqing, People’s Republic of China
| | - Lin Li
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Zerong Liang
- Department of Endocrinology, Chongqing Red Cross Hospital, People’s Hospital of Jiangbei District, Chongqing, 400020, People’s Republic of China
| | - Yaqin Chen
- Department of Endocrinology, The People’s Hospital of Shizhu, Chongqing, People’s Republic of China
| | - Deqing Chen
- Department of Endocrinology, The People’s Hospital of Rongchang, Chongqing, People’s Republic of China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
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Chatwin KE, Abbott CA, Rajbhandari SM, Reddy PN, Bowling FL, Boulton AJM, Reeves ND. An intelligent insole system with personalised digital feedback reduces foot pressures during daily life: An 18-month randomised controlled trial. Diabetes Res Clin Pract 2021; 181:109091. [PMID: 34653566 DOI: 10.1016/j.diabres.2021.109091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
AIMS High plantar pressure is a major risk factor in the development of diabetic foot ulcers (DFUs) and recent evidence shows plantar pressure feedback reduces DFU recurrence. This study investigated whether continued use of an intelligent insole system by patients at high-risk of DFUs causes a reduction in plantar pressures. METHODS Forty-six patients with diabetic peripheral neuropathy and previous DFU were randomised to intervention (IG) or control groups (CG). Patients received an intelligent insole system, consisting of pressure-sensing insoles and digital watch. Patients wore the device during all daily activity for 18-months or until ulceration, and integrated pressure was recorded continuously. The device provided high-pressure feedback to IG only via audio-visual-vibrational alerts. High-pressure parameters at the whole foot, forefoot and rearfoot were compared between groups, with multilevel binary logistic regression analysis. RESULTS CG experienced more high-pressure bouts over time than IG across all areas of the foot (P < 0.05). Differences between groups became apparent >16 weeks of wearing the device. CONCLUSIONS Continuous plantar pressure feedback via an intelligent insole system reduces number of bouts of high-pressure in patients at high-risk of DFU. These findings suggest that patients were learning which activities generated high-pressure, and pre-emptively offloading to avoid further alerts.
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Affiliation(s)
- Katie E Chatwin
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Oxford Road, Manchester M1 5GD, UK.
| | - Caroline A Abbott
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Oxford Road, Manchester M1 5GD, UK; Manchester Metropolitan University Institute of Sport, Manchester, UK
| | | | - Prabhav N Reddy
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Frank L Bowling
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Andrew J M Boulton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; Diabetes Research Institute, University of Miami, 1450 N.W. 10th Avenue, Miami, FL 33136, USA
| | - Neil D Reeves
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Oxford Road, Manchester M1 5GD, UK; Manchester Metropolitan University Institute of Sport, Manchester, UK
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Jongebloed-Westra M, Bode C, van Netten JJ, Ten Klooster PM, Exterkate SH, Koffijberg H, van Gemert-Pijnen JEWC. Using motivational interviewing combined with digital shoe-fitting to improve adherence to wearing orthopedic shoes in people with diabetes at risk of foot ulceration: study protocol for a cluster-randomized controlled trial. Trials 2021; 22:750. [PMID: 34711263 PMCID: PMC8551942 DOI: 10.1186/s13063-021-05680-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background Diabetic foot ulcers have a high impact on mobility and daily functioning and lead to high treatment costs, for example, by hospitalization and amputation. To prevent (re)ulcerations, custom-made orthopedic shoes are considered essential. However, adherence to wearing the orthopedic shoes is low, and improving adherence was not successful in the past. We propose a novel care approach that combines motivational interviewing (MI) with a digital shoe-fitting procedure to improve adherence to orthopedic shoes. The aim of this trial is to assess the (cost-)effectiveness of this novel care approach compared to usual care (no MI and casting-based shoe-fitting) in promoting footwear adherence and ulcer prevention. Methods The trial will include people with diabetes, with IWGDF Risk categories 1–3, who have been prescribed orthopedic shoes. Participants will be randomized at the level of the podiatrist to the novel care approach or usual care. The primary outcome is the proportion of participants who adhere to the use of their orthopedic shoes, that is, who take at least 80% of their total daily steps with orthopedic shoes. A temperature microsensor will be built into the participants’ orthopedic shoes to measure wearing time continuously over 12 months. In addition, daily activity will be measured periodically using log data with an activity monitor. Data from the temperature microsensor and activity monitor will be combined to calculate adherence. (Re-)experienced complications after receiving orthopedic shoes will be registered. Questionnaires and interviews will measure the experiences of participants regarding orthopedic shoes, experiences of podiatrists regarding motivational interviewing, care consumption, and quality of life. Differences in costs and quality of life will be determined in a cost-effectiveness analysis. Discussion This trial will generate novel insights into the socio-economic and well-being impact and the clinical effectiveness of the novel care approach on adherence to wearing orthopedic shoes. Trial registration Netherlands Trial Register NL7710. Registered on 6 May 2019
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Affiliation(s)
- M Jongebloed-Westra
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands.
| | - C Bode
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
| | - J J van Netten
- Department of Rehabilitation, Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ,, Amsterdam, The Netherlands.,Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, PO Box 7600, 7600 SZ,, Almelo, The Netherlands
| | - P M Ten Klooster
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
| | - S H Exterkate
- Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK,, Hengelo, The Netherlands.,Voetmax Orthopedie, Sabina Klinkhamerweg 10, 7555 SK,, Hengelo, The Netherlands
| | - H Koffijberg
- Department of Health Technology and Services Research, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
| | - J E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, TechMed Centre, University of Twente, PO Box 217, 7500 AE,, Enschede, The Netherlands
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van Netten J, Keukenkamp R, Busch-Westbroek T, Bus S. Plantar pressures and adherence in a combination of indoor and regular custom-made footwear for people with diabetes at high risk of foot ulceration. FOOTWEAR SCIENCE 2021. [DOI: 10.1080/19424280.2021.1916613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jaap van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Renske Keukenkamp
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Tessa Busch-Westbroek
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sicco Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Stevens TT, Hartline JT, Ojo O, Grear BJ, Richardson DR, Murphy GA, Bettin CC. Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses. Foot Ankle Int 2021; 42:894-901. [PMID: 33588617 DOI: 10.1177/1071100721990343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study looked at the effect of patient demographics, insurance status, education, and patient opinion on whether various orthotic footwear prescribed for a variety of diagnoses were received by the patient. The study also assessed the effect of the orthoses on relief of symptoms. METHODS Chart review documented patient demographics, diagnoses, and medical comorbidities. Eligible patients completed a survey either while in the clinic or by phone after their clinic visit. RESULTS Of the 382 patients prescribed orthoses, 235 (61.5%) received their orthoses; 186 (48.7%) filled out the survey. Race and whether or not the patient received the orthosis were found to be significant predictors of survey completion. Race, type of insurance, and amount of orthotic cost covered by insurance were significant predictors of whether or not patients received their prescribed orthoses. Type of orthosis, diabetes as a comorbidity, education, income, sex, and diagnosis were not significant predictors of whether the patient received the orthosis. Qualitative results from the survey revealed that among those receiving their orthoses, 87% experienced improvement in symptoms: 21% felt completely relieved, 66% felt better, 10% felt no different, and 3% felt worse. CONCLUSION We found that white patients had almost 3 times the odds of receiving prescribed orthoses as black patients, even after controlling for type of insurance, suggesting race to be the primary driver of discrepancies, raising the question of what can be done to address these inequalities. While large, systematic change will be necessary, some strategies can be employed by those working directly in patient care, such as informing primary care practices of their ability to see patients with limited insurance, limiting blanket refusal policies for government insurance, and educating office staff on how to efficiently work with Medicare and Medicaid. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Trenton T Stevens
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | | | | | - Benjamin J Grear
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - David R Richardson
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - G Andrew Murphy
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Clayton C Bettin
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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Keukenkamp R, Busch‐Westbroek TE, Barn R, Woodburn J, Bus SA. Foot ulcer recurrence, plantar pressure and footwear adherence in people with diabetes and Charcot midfoot deformity: A cohort analysis. Diabet Med 2021; 38:e14438. [PMID: 33084095 PMCID: PMC8048542 DOI: 10.1111/dme.14438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/30/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
AIMS To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. METHODS Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom-made footwear were assessed with regard to barefoot and in-shoe plantar pressures during walking, footwear adherence (% of daily steps over 7-day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non-Charcot foot group) with custom-made footwear and similar ulcer risk factors. RESULTS Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non-Charcot foot group [756 (260-1267) vs 146 (100-208) kPa; P<0.001]. In-shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104-201) vs 119 (94-160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non-Charcot foot group [median (interquartile range) 94.4 (85.4-95.0)% vs. 64.3 (25.4-85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non-Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non-Charcot foot group (1/55; P=0.001). CONCLUSIONS Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom-made footwear design may be required to improve clinical outcome.
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Affiliation(s)
- R. Keukenkamp
- Amsterdam UMCUniversity of Amsterdam, Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - T. E. Busch‐Westbroek
- Amsterdam UMCUniversity of Amsterdam, Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - R. Barn
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - J. Woodburn
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - S. A. Bus
- Amsterdam UMCUniversity of Amsterdam, Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
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Govindasamy K, Raja NR, Gupta P, Anand G, Das P, Darlong F, Darlong J. Computer assisted customized footwear and traditional micro-cellular rubber (MCR) footwear to reduce recurrence of ulcer for patients with loss of sensation due to leprosy. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hasanpour Dehkordi A, Chin YF, Huang TT, Ebadi A, Ghanei Gheshlagh R. Psychometric evaluation of the Farsi version of the diabetes foot self-care bahavior scale. J Foot Ankle Res 2020; 13:68. [PMID: 33256822 PMCID: PMC7708251 DOI: 10.1186/s13047-020-00437-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetes foot self-care is one of the self-management behaviors of diabetic patients leading to a reduction in the incidence of pressure ulcers and amputation. Having a valid, reliable, simple and comprehensive tool is essential in measuring the self-care behavior of diabetic patients. The aim of this study was to evaluate the psychometric properties of the Farsi version of the diabetes foot self-care bahavior scale (DFSBS) in Iran. METHODS In this cross-sectional and methodological study, 500 patients with type 2 diabetes were recruited by convenience sampling. Construct validity was assessed by exploratory factor analysis (over 300 patients) and confirmatory factor analysis (over 200 patients). Internal consistency was calculated by Cronbach's alpha coefficient and its stability was calculated by intraclass correlation coefficient (ICC). RESULTS In the exploratory factor analysis, two self-care factors related to feet and shoes were extracted which had specific values of 38.49 and 1.24, respectively, and were able to account for 56.22% of the total self-care variance of diabetes foot. Confirmatory factor analysis had excellent fit model. The internal consistency and ICC of the whole instrument were 0.83 and 0.791 (95% CI: 0.575-0.925; P < 0.001), respectively. CONCLUSIONS The Farsi version of DFSBS (F-DFSBS) has good validity and reliability, and due to its appropriate psychometric properties, this tool can be used in future studies.
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Affiliation(s)
- Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Yen-Fan Chin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tzu-Ting Huang
- Healthy Aging Research Center, and School of Nursing, Chang Gung University, Taoyuan City, Taiwan
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Ploeger HE, Bus SA, Brehm MA, Nollet F. Use and usability of custom-made dorsiflexion-restricting ankle-foot orthoses for calf muscle weakness in polio survivors: a cross-sectional survey. Eur J Phys Rehabil Med 2020; 56:575-584. [DOI: 10.23736/s1973-9087.20.06020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alahakoon C, Fernando M, Galappaththy C, Matthews EO, Lazzarini P, Moxon JV, Golledge J. Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 2020; 37:1266-1279. [PMID: 32426872 DOI: 10.1111/dme.14323] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim of this study was to perform an up-to-date systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of home foot temperature monitoring, patient education and offloading footwear in reducing the incidence of diabetes-related foot ulcers. METHODS A literature search was performed using MEDLINE, PubMed, CINAHL, Scopus and Cochrane databases to identify relevant original studies. Meta-analyses were performed using intention-to-treat principals for worst (main analysis) and best (sub-analysis) case scenarios. Leave-one-out sensitivity analyses were used to assess the consistency of findings. RESULTS Of 7575 unique records, 17 RCTs involving 2729 participants were included. Four tested home foot temperature monitoring (n = 468), six examined patient education (n = 823) and seven assessed offloading footwear (n = 1438). Participants' who performed home foot temperature monitoring [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.31 to 0.84; n = 468] and those provided offloading footwear (OR 0.48, 95% CI 0.29 to 0.80; n = 1438) were less likely to develop a diabetes-related foot ulcer. Patient education programmes did not significantly reduce diabetes-related foot ulcer incidence (OR 0.59, 95% CI 0.29 to 1.20; n = 823). Sensitivity analyses suggested that offloading footwear findings were consistent, but home foot temperature findings were dependent on the individual inclusion of one trial. All RCTs had either high or unclear risk of bias. CONCLUSION This meta-analysis suggests that offloading footwear is effective in reducing the incidence of diabetes-related foot ulcers. Home foot temperature monitoring also appears beneficial but larger trials are needed (PROSPERO registration no.: CRD42019135226).
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Affiliation(s)
- C Alahakoon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M Fernando
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - C Galappaththy
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
| | - E O Matthews
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
| | - P Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - J V Moxon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - J Golledge
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
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Jarl G, Tranberg R, Johansson U, Alnemo J, Lundqvist LO. Predictors of adherence to wearing therapeutic footwear among people with diabetes. J Foot Ankle Res 2020; 13:45. [PMID: 32660610 PMCID: PMC7359292 DOI: 10.1186/s13047-020-00413-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Aims People at increased risk of developing diabetic foot ulcers often wear therapeutic footwear less frequently than is desirable. The aims were to identify patient groups prone to nonadherence to wearing therapeutic footwear and modifiable factors associated with adherence. Materials and methods A questionnaire was mailed to 1230 people with diabetes who had been fitted with therapeutic footwear. Independent variables were categorized into five domains. For each domain, variables that were associated with adherence in a univariate regression analysis were entered into a multiple regression analysis. Results A total of 429 (34.9%) questionnaires were analyzed. Multiple regression analyses showed significant associations (p < 0.05) between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear, and a belief that therapeutic footwear promotes ulcer healing. The five multivariate models explained 2–28% of the variance in adherence, with the strategies for footwear use domain explaining the most. Conclusions Patients without paid employment or without foot ulcer experience are more prone to nonadherence. To improve adherence, clinicians should advise patients to store therapeutic footwear in a visible place at home and put conventional footwear away and encourage patients’ self-efficacy and habitual use of therapeutic footwear. Future studies should investigate this topic further and explore ways to promote changes in habits. A study limitation was that all variables were self-reported.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ulf Johansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - John Alnemo
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Potier L, François M, Dardari D, Feron M, Belhatem N, Nobecourt-Dupuy E, Dolz M, Bordier L, Ducloux R, Chibani A, Eveno DF, Crea Avila T, Sultan A, Baillet-Blanco L, Rigalleau V, Gand E, Saulnier PJ, Velho G, Roussel R, Pellenc Q, Dupré JC, Malgrange D, Marre M, Mohammedi K. Comparison of a new versus standard removable offloading device in patients with neuropathic diabetic foot ulcers: a French national, multicentre, open-label randomized, controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e000954. [PMID: 32393479 PMCID: PMC7223015 DOI: 10.1136/bmjdrc-2019-000954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The offloading is crucial to heal neuropathic diabetic foot ulcer (DFU). Removable offloading are the most used devices. Orthèse diabète is a new customized removable knee-high offloading device immobilizing foot and ankle joints, with some specific and innovative features that may improve offloading. We aimed to evaluate the efficiency of this device in DFU healing. RESEARCH, DESIGN AND METHODS The evaluation of Offloading using a new removable ORTHOsis in DIABetic foot study is a French multicenter (13 centers) randomized controlled trial with blinded end points evaluation. Adults with neuropathic DFU were randomly assigned to either Orthèse Diabète (experimental device), or any type of conventional (usually used in France) removable offloading devices (control group). The primary outcome was the 3-month proportion of patients with fully healed DFU. RESULTS Among 112 randomized patients (men 78%, age 62±10 years), the primary outcome occurred in 19 (33%) participants using conventional device vs 19 (35%) Orthèse Diabète users (p=0.79). Study groups were also comparable in terms of prespecified secondary end points including occurrence of new DFU (25% vs 27% in conventional and experimental groups), ipsilateral lower-limb amputation (4% vs 10%) or infectious complications (14% vs 13%) (p>0.05 for all). Adverse events were comparable between groups, including 4 deaths unrelated to study allocation (1 sudden death, 2 ventricular arrhythmias and 1 pancreatic cancer). Adverse events believed to be related to the device were higher in the Orthèse Diabète group than in the control group (15% vs 4%). Orthèse Diabète was less frequently worn than conventional devices (46% vs 66%, p=0.04). CONCLUSIONS Orthèse Diabète, a new removable offloading orthosis immobilizing foot and ankle joints did not show superiority compared with conventional removable devices in neuropathic DFU healing and cannot be recommended to heal DFU. TRIAL REGISTRATION NUMBER NCT01956162.
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Affiliation(s)
- Louis Potier
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- Université de Paris, Paris, Île-de-France, France
| | - Maud François
- Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Dured Dardari
- Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, Paris, France
| | - Marilyne Feron
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Narimene Belhatem
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Estelle Nobecourt-Dupuy
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Universitaire de la Réunion, Saint Denis de la Réunion, France
| | - Manuel Dolz
- Endocrinology Department, Hôpital Bégin, Saint-Mandé, France
| | - Lyse Bordier
- Endocrinology Department, Hôpital Bégin, Saint-Mandé, France
| | - Roxane Ducloux
- APHP, Hôpital Corentin-Celton, Centre de Cicatrisation du Pied du Diabétique, Issy les Moulineaux, France
| | - Abdelkader Chibani
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Gonesse, Gonesse, France
| | - Dominique-François Eveno
- Department of Functional Rehabilitation, Centre Hospitalier La Tourmaline, La Tourmaline, France
| | - Teresa Crea Avila
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Régional de Metz-Thionville, Thionville, France
| | - Ariane Sultan
- Department of Endocrinology, Diabetology and Nutrition, CHRU Montpellier, Montpellier, France
- INSERM U1046, University of Montpellier 1, Montpellier, France
| | - Laurence Baillet-Blanco
- Department of Endocrinology, Diabetology and Nutrition, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetology and Nutrition, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- Department of Life and Health Sciences, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Elise Gand
- INSERM CIC 1402, University of Poitiers, CHU Poitiers, Poitiers, France
| | | | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Ronan Roussel
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Quentin Pellenc
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Jean-Claude Dupré
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Dominique Malgrange
- Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Michel Marre
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetology and Nutrition, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- Department of Life and Health Sciences, University of Bordeaux, Bordeaux, Aquitaine, France
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Emerging technologies for the prevention and management of diabetic foot ulcers. J Tissue Viability 2020; 29:61-68. [DOI: 10.1016/j.jtv.2020.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
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