Could Custom Footwear Improve Adherence In An Ulcer Remission Program?

Important work from our Dutch SALSAmigos.¹ Can it help guide us to work with our patients to improve adherence and #ActAgainstAmputation?

The authors took a closer look at adherence to footwear usage when patients with diabetes at high-risk for ulceration had custom-made shoes.¹ Researchers assessed the percentage of overall steps during which subjects wore their custom-made shoes indoors and outdoors at baseline, 1-, and 12-months post-shoe dispensing. They created two cohorts based on indoor baseline adherence to shoe gear, less than 80% (primary group, n = 23) and greater or equal to 80% (secondary group n = 8). The authors also looked at peak plantar pressures of custom vs. non-custom indoor footwear, patient-related usability of the custom shoes, and ulcer recurrence at 12 months.¹

The primary group saw an increase in overall median adherence to shoe gear from baseline to 1 month and 12 months of 65, 77 and 87 percent, respectively.¹ Indoor adherence gains were even more significant. The authors related relatively comparable plantar pressures between the custom and non-custom footwear and overall positive usability assessments from the patients. At 12 months, ulcer recurrence rate among the subjects was 26 percent.¹

Providers may want to consider crafting or honing a follow-up algorithm after dispensing custom shoes or traditional diabetic shoes, looking at the data from this study. It really is an exciting time to be a podiatric surgeon. We now have the capability to ease people in diabetic foot remission back into activity, dosing activity as we might dose a drug. Please see here for guidelines we use at our USC / Rancho Limb Preservation Program. Remote monitoring systems, including data from smart bath mats, smart shoes and smart socks are emerging into what may one day be a standard of care, but can certainly be part of a follow-up program for ulcer remission.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s note: This blog originally appeared at:https://diabeticfootonline.com/2022/02/13/custom-made-footwear-designed-for-indoor-use-increases-short-term-and-long-term-adherence-in-people-with-diabetes-at-high-ulcer-risk-actagainstamputation-shoes-diabeticfoot-diabetesrc/. It is adapted with permission from the author.

Reference

1. 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:e002593.