THERAPEUTIC FOOTWEAR CAN REDUCE PLANTAR PRESSURES IN PATIENTS WITH DIABETES AND TRANSMETATARSAL AMPUTATION

OBJECTIVE - To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle -foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and tra nsmetatarsal amputation (TMA). RESEARCH DESIGN AND METHODS - Thirty pa tients with diabetes and TMA participated (mean age 62 +/- 4 years). I n-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare tre atments. RESULTS - All five types of therapeutic footwear reduced plan tar pressures compared with. regular shoes with a toe-filler (P < 0.05 ). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regu lar shoe and toe-filler. Footwear with an AFO showed reduced PPP on th e residuum, but most patients complained of reduced ankle motion durin g walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regardin g cosmesis of the shoe. CONCLUSIONS - The full-length shoe, total cont act insert, and an RRB sole provided the best pressure reduction for t he residuum and contralateral foot, with the optimal compromise for co smetic acceptance and function.