When selecting the proper footwear or inner sole to relieve pressure on diabetic patients’ feet, there is no one size fits all solution. Diabetes patients’ body mass index (BMI) tells how firm or soft the cushioning material in shoes should be.
The results of research led by Panagiotis Chatzistergos of Staffordshire University in the UK are published in an article in Springer’s journal Annals of Biomedical Engineering. This research offers the first scientific support for the idea that healthcare professionals should offer their diabetic patients customized foot care.
Previous studies have demonstrated that how effectively diabetes patients’ feet respond to therapy depends on the stiffness of the materials used to cushion their feet. However, there aren’t any established rules that may tell medical experts which stiffness is best for certain people at the moment.
In order to make such decisions, practitioners now rely on empirical and anecdotal evidence, claims Chatzistergos. The Staffordshire team and their partners set out to uncover scientific data on which to base such decisions as part of their ongoing study into diabetic footwear.
Various bespoke polyurethane (BPU) cushioning materials were created using industry-standard footwear production methods and chemical ingredients that are readily available. The mechanical properties of these materials were identical, but their stiffness varied.
The feet of ten healthy adult volunteers and a 3D-printed model of a heel were then used in various mechanical testing. To evaluate the mechanical qualities of the tested insole materials, particularly their cushioning capabilities, pressure measurements were made across the full region of the foot.
The results emphasize how crucial it is to take a person’s weight and body mass index (BMI) into account when selecting cushioning materials. To relieve pressure, people who weigh more or have a higher BMI need stronger insoles or footwear materials.
Because pressure is typically not distributed equally across a person’s left and right feet, different materials may also be required for the patient’s left and right feet. The findings also suggest that increasing the stiffness of padding materials can at least 16% and 19% lessen pressure during standing and walking, respectively.
Using different material to minimise pressure could further enhance the offloading capacity of therapeutic footwear and orthoses, as long as it doesn’t have a detrimental effect on gait and postural balance.
Panagiotis Chatzistergos
It was also discovered that different materials varied in the kind of pressure they minimize the best when a person stands or walks. For example, stronger materials are required for walking.
This, according to Chatzistergos, suggests that healthcare professionals should take different cushioning materials into account for their patients who are extremely active as opposed to those who lead sedentary lifestyles.
“Using different material to minimise pressure could further enhance the offloading capacity of therapeutic footwear and orthoses, as long as it doesn’t have a detrimental effect on gait and postural balance,” adds Chatzistergos, who notes that more testing is needed to develop clinically relevant material selection methods.
According to the results, optimum stiffness could be predicted without the need for time-consuming and expensive studies like gait analysis and plantar pressure assessments, which will have an impact on clinical care that is successful.
Nachiappan Chockalingam, who leads the clinical biomechanics team at Staffordshire University said:
“Every 20 seconds someone in the world is losing their limbs to diabetic foot complications. Our work focuses on prognosis and prevention of diabetic foot complications in addition to effective treatment options. We strongly believe that this study will influence the material selection process for any prescription footwear.”
