Preece Stephen J, Chapman Jonathan D, Braunstein Bjoern, Brüggemann Gert-Peter, Nester Christopher J
Centre for Health Sciences Research, University of Salford, Salford, Manchester, M6 6PU UK.
Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany.
J Foot Ankle Res. 2017 Jul 6;10:27. doi: 10.1186/s13047-017-0208-3. eCollection 2017.
Appropriate footwear for individuals with diabetes but no ulceration history could reduce the risk of first ulceration. However, individuals who deem themselves at low risk are unlikely to seek out bespoke footwear which is personalised. Therefore, our primary aim was to investigate whether group-optimised footwear designs, which could be prefabricated and delivered in a retail setting, could achieve appropriate pressure reduction, or whether footwear selection must be on a patient-by-patient basis. A second aim was to compare responses to footwear design between healthy participants and people with diabetes in order to understand the transferability of previous footwear research, performed in healthy populations.
Plantar pressures were recorded from 102 individuals with diabetes, considered at low risk of ulceration. This cohort included 17 individuals with peripheral neuropathy. We also collected data from 66 healthy controls. Each participant walked in 8 rocker shoe designs (4 apex positions × 2 rocker angles). ANOVA analysis was then used to understand the effect of two design features and descriptive statistics used to identify the group-optimised design. Using 200 kPa as a target, this group-optimised design was then compared to the design identified as the best for each participant (using plantar pressure data).
Peak plantar pressure increased significantly as apex position was moved distally and rocker angle reduced ( < 0.001). The group-optimised design incorporated an apex at 52% of shoe length, a 20° rocker angle and an apex angle of 95°. With this design 71-81% of peak pressures were below the 200 kPa threshold, both in the full cohort of individuals with diabetes and also in the neuropathic subgroup. Importantly, only small increases (<5%) in this proportion were observed when participants wore footwear which was individually selected. In terms of optimised footwear designs, healthy participants demonstrated the same response as participants with diabetes, despite having lower plantar pressures.
This is the first study demonstrating that a group-optimised, generic rocker shoe might perform almost as well as footwear selected on a patient by patient basis in a low risk patient group. This work provides a starting point for clinical evaluation of generic versus personalised pressure reducing footwear.
对于没有溃疡病史的糖尿病患者，合适的鞋类可以降低首次出现溃疡的风险。然而，那些认为自己风险较低的人不太可能去寻求定制的个性化鞋类。因此，我们的主要目的是研究在零售环境中预制并交付的群体优化鞋类设计是否能实现适当的压力降低，或者鞋类选择是否必须逐患者进行。第二个目的是比较健康参与者和糖尿病患者对鞋类设计的反应，以便了解在健康人群中进行的先前鞋类研究的可转移性。
记录了102名被认为溃疡风险较低的糖尿病患者的足底压力。该队列包括17名患有周围神经病变的患者。我们还从66名健康对照者那里收集了数据。每位参与者穿着8种摇椅鞋设计行走（4个顶点位置×2个摇椅角度）。然后使用方差分析来了解两种设计特征的效果，并使用描述性统计来确定群体优化设计。以200kPa作为目标，然后将这种群体优化设计与为每位参与者确定的最佳设计（使用足底压力数据）进行比较。
随着顶点位置向远端移动且摇椅角度减小，足底峰值压力显著增加（<0.001）。群体优化设计在鞋长的52%处设置顶点、摇椅角度为20°且顶角为95°。采用这种设计，在整个糖尿病患者队列以及神经病变亚组中，71% - 81%的峰值压力低于200kPa阈值。重要的是，当参与者穿着单独挑选的鞋类时，这一比例仅出现了小幅增加（<5%）。在优化鞋类设计方面，尽管健康参与者的足底压力较低，但他们与糖尿病患者的反应相同。
这是第一项表明群体优化的通用摇椅鞋在低风险患者群体中可能几乎与逐患者挑选的鞋类表现一样好的研究。这项工作为通用与个性化减压鞋类的临床评估提供了一个起点。
