In-depth pressure analysis of indoor versus regular custom-made footwear for people with diabetes and peripheral neuropathy

L.E. Vossen^1,2, J.J. van Netten^1,2, S.A. Bus^1,2

1. Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; 2. Amsterdam Movement Sciences, Rehabilitation&Development, Amsterdam, The Netherlands; l.e.vossen@amsterdamumc.nl

Background: Custom-made indoor footwear is a promising alternative to regular custom-made footwear for people with diabetes and peripheral neuropathy to wear inside their home. Previous research has shown similar peak pressures, however, an in-depth analysis of the pressure distribution during the entire gait cycle has never been performed. This is needed to ensure that indoor footwear is a biomechanically safe replacement for regular footwear.

Methods: Custom-made indoor footwear was provided to 23 participants with diabetes, peripheral neuropathy and a recently healed plantar foot ulcer or (partial) foot amputation. In-shoe plantar pressure was measured during walking in regular and indoor custom-made footwear. Multiple peak pressure parameters were extracted to compare pressure distribution in spatial and temporal domains between both footwear types using statistical parametric mapping.

Results: There were no significant differences between both footwear types in any pressure parameter. Maximum peak pressure was 194 (SD:45) vs. 186 (SD:48) kPa (p=.33), pressure time integral was 88 (SD:19) vs. 88 (SD:22) kPa.s (p=.87), and pressure gradient was 12 (SD:4) vs 12 (SD:5) kPa/mm (p=.66) for indoor vs. regular footwear respectively. Maximum peak pressure occurred at the first metatarsal head at 80% of the step for both shoes. Pressure time map analysis showed small but statistically non-significant differences (Fig.1).

Discussion/Conclusion: No significant differences were found in pressure distribution between both footwear types. It may therefore be assumed that indoor custom-made footwear is a safe offloading alternative for people with diabetes and peripheral neuropathy to wear inside their home on group level. Follow-up analyses should focus on analyzing effects on individual or subgroup level.