Footwear and orthoses for diabetic patients

Does user perception affect adherence when wearing biomechanically optimised ankle foot orthosis - footwear combinations: A pilot study

STUDY DESIGN

Pilot study.

BACKGROUND

Ankle foot orthoses (AFOs) and footwear combination (FC) is a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. Biomechanically optimising the AFO-FC often requires large adaptations to the sole of the user's footwear. There is currently a dearth of literature regarding the user's perception of wearing biomechanically optimised AFOs and adapted footwear and whether their perception affects their adherence to orthotic treatment.

OBJECTIVE

This study aimed to investigate perception and adherence to wearing an AFO and FC the participants were asked to wear as part of their orthotic prescription. In particular, whether the visibly modified footwear affected the user's adherence to the orthotic treatment.

METHODS

Questionnaire devised for the purpose of this study.

RESULTS

All five participants responded to the questionnaire; reporting a high number of positive responses in relation to function, including; an improvement in the way they walked, improved balance and fewer falls. Conversely, there was a high level of negative responses regarding aesthetics, with all participants reporting they did not like the cosmesis of their AFO-FCs. They were conscious that the modification to their footwear was noticeable and therefore different from their peers, yet they adhered to the treatment and in some cases increased the wearing time.

CONCLUSIONS

This pilot set of questions indicated that cosmesis is an important factor for children who wear AFOs and adapted footwear. It can be concluded that the impact of the adapted AFO-FC on the participants' function outweighed their opinion on the cosmesis of the device.

CLINICAL RELEVANCE

It is vital to understand how orthotic prescriptions affect user adherence. Orthotic prescriptions which are not utilised by the user result in a failed treatment intervention, regardless of the scientific application underpinning them.

Patient perceptions of stock footwear design features

Patients with diseases which impact on foot health, for example diabetes and rheumatoid arthritis, are known to have some benefit from prescribed stock footwear with regards to clinical outcomes. Achieving this is not just about getting the footwear designed and fitted to meet the clinical needs, but it also requires that the patient wears the shoes. This means meeting the non-clinical needs or criteria of patients. The aim of this study was to compare perceptions of the same footwear between patients with diabetes and patients with rheumatoid arthritis (RA) with regard to specific design features. Fifty-four patients with RA and 40 patients with diabetes who required prescription footwear were asked to identify issues of importance, and to assess the features of five different pairs of stock footwear using a Likert scale scoring form. There was a difference between the RA and the diabetes groups with regards their overall requirements from the footwear with comfort being a priority in RA and style a priority for diabetes. Both groups rated the same footwear as overall best from the selection, but the scores suggest that there were features with the 'best' shoe which were not acceptable suggesting that even the 'best' shoe was a compromise This possibly indicates that existing footwear ranges do not meet all the patients' requirements. Patients have different perceptions with regard to what is important to them in terms of footwear with regards to the specific features of the footwear and one of the influences appears to be the underlying systemic disease. Patient-based criteria may be an important consideration in the design of the footwear.

Changing perspectives in diabetic foot ulcer management

Diabetic foot ulceration is a serious complication of diabetes mellitus; it is the cause of more than half of nontraumatic lower limb amputations. Diabetic foot ulcers are the major cause of hospital admission for diabetic patients. Treatment costs are high. There have been advances in managing diabetic foot ulceration with the development of new dressings, growth factors, skin substitutes, and other novel approaches to stimulating wound healing. The management of vascular disease in the patient with diabetes mellitus is an essential and important consideration. However, the need for a multidisciplinary team to provide good foot care to diabetic patients is still vital for the prevention and treatment of diabetic foot ulceration.

Knowledge and practice of foot care in people with diabetes

AIM

To determine knowledge and practice of foot care in people with diabetes.

METHODS

A questionnaire was completed by patients in Middlesbrough, South Tees, UK. A knowledge score was calculated and current practice determined. Practices that put patients at risk of developing foot ulcers and barriers to good practice were identified. Patients at high risk of ulceration were compared to those at low risk.

RESULTS

The mean knowledge score was 6.5 (S.D. 2.1) out of a possible 11. There was a positive correlation between the score and having received advice on foot care (6.9 versus 5.4, P = 0.001). Deficiencies in knowledge included the inability to sense minor injury to the feet (47.3%), proneness to ulceration (52.4%) and effect of smoking on the circulation (44.5%). 24.6% (20.1-29.2) never visited a chiropodist, 18.5% (14.2-22.7) failed to inspect their feet and 83% (79.1-86.9) did not have their feet measured when they last purchased shoes. Practices that put patients at risk included use of direct forms of heat on the feet and walking barefoot. Barriers to practice of foot care were mainly due to co-morbidity. Those with high risk feet showed a higher (6.8) but not significant knowledge score compared to those at low risk (6.5) and their foot care practise was better.

CONCLUSION

The results highlight areas where efforts to improve knowledge and practice may contribute to the prevention of foot ulcers and amputation.

Medical opinions, beliefs and prescription of orthopaedic footwear: a survey of Dutch orthopaedists and rehabilitation practitioners

OBJECTIVES

To get insight into medical opinions about the use of orthopaedic footwear and the medical and social factors related to the prescription of orthopaedic footwear by orthopaedists and rehabilitation practitioners.

METHODS

In this study 85 orthopaedists and 96 rehabilitation practitioners filled out a questionnaire measuring perceived desirability of prescribing orthopaedic footwear in specific medical conditions, the perceived advantages of orthopaedic footwear, the perceived disadvantages of orthopaedic footwear, the attitude to orthopaedic footwear and satisfaction with the co-operation with the pedorthist. Clinicians were asked to estimate their referral rate of orthopaedic footwear.

RESULTS

Orthopaedists and rehabilitation practitioners agree that the prescription of orthopaedic footwear should be considered in the case of rheumatoid arthritis, amputation of the foot and diabetic foot and not be considered in the case of sprain and back pain. In the case of hallux valgi, dermatological problems and clavus (severe corn) a reticent prescription policy seems to be the optimal choice. In the other medical conditions studied no unequivocal prescription policy could be derived. Respondents who prescribed orthopaedic footwear more than the median (more than 50 prescriptions per year) were more often rehabilitation practitioner, perceived more advantages of prescription footwear, perceived less disadvantages of prescription footwear and were more satisfied about the co-operation with the pedorthist.

CONCLUSION

In some medical conditions orthopaedists and rehabilitation practitioners agree about the optimal use of orthopaedic footwear. In some other medical conditions orthopaedists and rehabilitation practitioners are divided about the use of orthopaedic footwear. Reported rate of prescription was not related to desirability of prescription, but was related to beliefs such as perceived advantages, perceived disadvantages and satisfaction with co-operation with the pedorthist, underlining the importance of cognitive factors in prescription style.

The use of orthotic devices to correct plantar callus in people with diabetes

Foot problems are a major cause of morbidity in people with diabetes. Plantar callus is common and is a sign of abnormal foot pressures. Shear stresses at these areas of high foot pressures may ultimately result in ulcer formation. This study compared the effect on plantar callus of the use of rigid orthotic devices and conventional podiatric care. Twenty diabetic subjects participated in the study and were randomly allocated to conventional treatment (n = 11) or orthotic device treatment (n = 9). After 12 months the patients in the orthotic group showed a significant reduction in callus grade, whereas the conventionally treated group showed no significant change. There were no adverse effects from wearing the orthotic device. Rigid orthoses have a beneficial effect on plantar callus presumably through the lowering and redistribution of abnormal foot pressures.