Learning from experience: A simple effective protocol to test footwear prescriptions for the Diabetic foot by using the Pedar system

Abstract

Adherence of patients to treatment and appropriateness\rof prescribed footwear are mandatory for successful prevention of Diabetic\rfoot ulceration. In a Public Healthcare Service, footwear approval is under\rthe responsibility of the clinician. In some cases kinetic measurements are\rtaken inside the shoes to support the clinical decision; however, an overall\ragreement is still missing with respect to a simple, reliable and effective\rtest protocol based on proper threshold values. Authors’ past experiences,\rspecific needs of the Diabetic outpatient service, and suggestions from\rvaluable literature led to an instrumental test protocol based on reference\rpeak pressure (PP) thresholds and gait line (GL) specific for each level of risk.\rPermission was obtained for one preliminary validation session at the Authors’\routpatient service, during which 11 patients at high/very high risk of\rulceration were examined—9 for testing new footwear, 2 for monitoring\r12-month-old footwear. The protocol was well accepted by patients and operators,\rfast and easy to be used. Based on the instrumental, clinical and visual\rinspection data; 4 new footwear did not pass the test; 5 passed the test but\rintegration or minor changes were requested; the 2 old footwear were found no\rmore effective. As a first positive feedback, after 4 months of wearing the\rmodified prescriptions none of the patients had developed plantar ulcers or\rsigns of tissue damage. Successive data processing proved that in all patients\raltered PPs and deviated GLs did correlate with alterations of other kinetic\rparameters. The protocol, which is proved to be sensitive and valuable for the Diabetic\rfoot care, may have a general validity; the delivered specific PP thresholds\rand reference data, instead, can be reliably used if the test is performed with\ra calibrated Pedar Insole System and with the wide Insoles in the range UW-YW\r(EU size 36 - 45).