THERAPEUTIC FOOTWEAR - ENHANCED FUNCTION IN PEOPLE WITH DIABETES AND TRANSMETATARSAL AMPUTATION

Objective: Patients with diabetes mellitus (DM) and a transmetatarsal amputation (TMA) have considerable deficits in function compared with age-matched controls. The purpose of this study was to determine if th erapeutic footwear could improve the functional mobility of patients w ith DM and TMA. Study Design: Repeated-measures design. Setting: Acade mic medical center. Patients: Thirty subjects (10 women, 20 men) with DM and a TMA, with a mean age of 61.7 +/- 4.0yrs. Interventions: Six t ypes of footwear evaluating the following components: length of shoe ( full-length or short shoe), a rigid rocker-bottom sole, and an ankle-f oot-orthosis. Outcome Measures: Physical Performance Test (PPT), funct ional reach, and walking speed. Measurements in each footwear conditio n occurred after a 1-month adjustment period. Results: Patients wearin g full-length custom-made shoes with a total-contact insert, a rigid r ocker-bottom sole or a short shoe with a rigid rocker-bottom sole (wit h or without an ankle-foot-orthosis) had similar and significantly hig her scores in the PPT and faster walking speed than when wearing regul ar shoes with a toe filler (p < .05). The short shoe and the ankle-foo t-orthosis, however, generated many patient complaints about cosmesis and restriction at the ankle, respectively. There were no differences in any of the measures of functional reach. Conclusion: Although there are individual exceptions, we recommend the full-length shoe, total-c ontact insert, and a rigid rocker-bottom sole for most patients with D M and a TMA. (C) 1997 by the American Congress of Rehabilitation Medic ine and the American Academy of Physical Medicine and Rehabilitation.