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The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy.

Lin TL, Sheen HM, Chung CT, Yang SW, Lin SY, Luo HJ, Chen CY, Chan IC, Shih HS, Sheu WH - J Foot Ankle Res (2013)

Bottom Line: Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs.With an arch support added, the pressure was further reduced (9.5%, P<0.001).These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec, 4, Taichung 407, Taiwan, Republic of China. whhsheu@vghtc.gov.tw.

ABSTRACT

Background: Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.

Methods: In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support).

Results: Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions.

Conclusions: These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.

No MeSH data available.


Related in: MedlinePlus

Coronal section view of the insole. (a) The plug-removed insole for an ulcerative foot. * A wound under MT2-3 area. # Wound dressings between the wound and insole. (b) The plug-removed insole for a foot without current ulcer.
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Figure 2: Coronal section view of the insole. (a) The plug-removed insole for an ulcerative foot. * A wound under MT2-3 area. # Wound dressings between the wound and insole. (b) The plug-removed insole for a foot without current ulcer.

Mentions: In the experiment, insoles with removable plugs were used (Dr. Foot Technology Co., Taiwan, R.O.C., Figure 1). These insoles consisted of three layers: 3 mm Shore A 35° EVA in the first layer, 2 mm velcro and velvet in the second layer, and 6 mm Shore A 50° PORON® in the third layer. The PORON® layer has a grid matrix design with small, removable square plugs measuring 1×1 cm2. Insoles with plugs removed have small holes with exposed edges which could potentially cause discomfort if there is no wound dressings positioned between the foot-insole interface. Therefore, the manufacturer suggested that patients with ulcer wounds should use the insoles with the plugs-removed PORON® layer face up as well as the wound dressings positioned between the wound and insole. For patients with no current plantar ulcer, the insole should be flipped over with the EVA layer on the top for local interface reduction (Figures 2a and 2b). In this way, the vulnerable foot can benefit from pressure offloading and also avoid the possible discomfort in the plantar foot area.


The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy.

Lin TL, Sheen HM, Chung CT, Yang SW, Lin SY, Luo HJ, Chen CY, Chan IC, Shih HS, Sheu WH - J Foot Ankle Res (2013)

Coronal section view of the insole. (a) The plug-removed insole for an ulcerative foot. * A wound under MT2-3 area. # Wound dressings between the wound and insole. (b) The plug-removed insole for a foot without current ulcer.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750449&req=5

Figure 2: Coronal section view of the insole. (a) The plug-removed insole for an ulcerative foot. * A wound under MT2-3 area. # Wound dressings between the wound and insole. (b) The plug-removed insole for a foot without current ulcer.
Mentions: In the experiment, insoles with removable plugs were used (Dr. Foot Technology Co., Taiwan, R.O.C., Figure 1). These insoles consisted of three layers: 3 mm Shore A 35° EVA in the first layer, 2 mm velcro and velvet in the second layer, and 6 mm Shore A 50° PORON® in the third layer. The PORON® layer has a grid matrix design with small, removable square plugs measuring 1×1 cm2. Insoles with plugs removed have small holes with exposed edges which could potentially cause discomfort if there is no wound dressings positioned between the foot-insole interface. Therefore, the manufacturer suggested that patients with ulcer wounds should use the insoles with the plugs-removed PORON® layer face up as well as the wound dressings positioned between the wound and insole. For patients with no current plantar ulcer, the insole should be flipped over with the EVA layer on the top for local interface reduction (Figures 2a and 2b). In this way, the vulnerable foot can benefit from pressure offloading and also avoid the possible discomfort in the plantar foot area.

Bottom Line: Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs.With an arch support added, the pressure was further reduced (9.5%, P<0.001).These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec, 4, Taichung 407, Taiwan, Republic of China. whhsheu@vghtc.gov.tw.

ABSTRACT

Background: Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.

Methods: In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support).

Results: Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions.

Conclusions: These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.

No MeSH data available.


Related in: MedlinePlus