Amputation, reulceration rates fall after two years of orthotic therapy
Orthotic therapy in patients with diabetes and a history of foot ulcers was associated with dramatic decreases in reulceration and amputation rates, according to data from Spanish researchers at the Universidad Complutense de Madrid.
The investigators assessed 117 patients’ biomechanics; none had undergone previous orthotic therapy. All reported some reduction in physical activity, and none were working at the study’s outset (48% were on sick leave).
The investigators prescribed custom insoles and footwear that were modified based on the gait analysis data. In patients with a rigid plantar flexed metatarsal joint, a fenestrated outsole covered by a rocker bottom was utilized.
After two years, reulceration rates fell from 79% to 15% and amputation rates declined from was 54% to 6%. Peak plantar pressures were reduced in patients both with and without reulceration, though only those without reulceration had significant decreases. All patients previously on sick leave had returned to work, and half the remaining patients had resumed their normal activities.
The investigators published the results in the July/August issue of the Journal of the American Podiatric Medical Association.
Gonzalez Fernandez ML, Lozano RM, Gonzalez-Quijano Diaz MI, et al. How effective is orthotic treatment in patients with recurrent diabetic foot ulcers? J Am Podiatr Med Assoc 2013;103(4): 281-290.