Zwaferink Jennefer B J, Custers Wim, Paardekooper Irma, Berendsen Heleen A, Bus Sicco A
Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
Penders Voetzorg, Reinier De Graafweg 1, 2625 AD, Delft, the Netherlands.
Gait Posture. 2021 May;86:341-345. doi: 10.1016/j.gaitpost.2021.04.010. Epub 2021 Apr 9.
Different shoe design features can reduce peak plantar pressure to help prevent foot ulcers in people with diabetes. A carbon reinforcement of the shoe outsole to maximize bending stiffness is commonly applied in footwear practice, but its effect has not been studied to date.
What is the effect of a carbon shoe-outsole reinforcement on peak plantar pressure and walking comfort in people with diabetes at high risk of foot ulceration?
In 24 high-risk people with diabetes, in-shoe regional peak pressures were measured during walking at a comfortable speed in two different shoe conditions: an extra-depth diabetes-specific shoe with a non-reinforced outsole and the same type of shoe with a 3-mm-thick full-length carbon reinforcement of the outsole. The same custom-made insole was worn in both shoe conditions. Walking comfort was assessed using a Visual Analogue Scale (0-10, 10 being highest possible comfort).
Significantly lower metatarsal head peak pressures (by a median 10-22 kPa) were found with the reinforced shoe compared to the non-reinforced shoe (p < .001). In >83% of cases with the reinforced shoe and >71% with the non-reinforced shoe metatarsal head peak pressures were <200 kPa. At the hindfoot, peak pressures were significantly higher (by a median 24 kPa) with the reinforced shoe (p = .001). No significant shoe effects were found for the toes. No significant shoe effects were found for walking comfort: median 6.1 for the reinforced shoe versus 5.6 for the non-reinforced shoe.
Adding a full-length carbon reinforcement to the outsole of a diabetes-specific shoe significantly reduces peak pressures at the metatarsal heads, where ulcers often occur, in high-risk people with diabetes, and this does not occur at the expense of patient-perceived walking comfort.
不同的鞋类设计特点可降低足底峰值压力，有助于预防糖尿病患者足部溃疡。鞋外底的碳增强材料可使弯曲刚度最大化，这在鞋类实践中普遍应用，但迄今为止其效果尚未得到研究。
碳鞋外底增强材料对足部溃疡高风险糖尿病患者的足底峰值压力和行走舒适度有何影响？
对24名足部溃疡高风险糖尿病患者，在两种不同鞋类条件下以舒适速度行走时测量鞋内局部峰值压力：一种是具有未增强外底的超深糖尿病专用鞋，另一种是外底有3毫米厚全长碳增强材料的同类型鞋。两种鞋类条件下均穿着相同的定制鞋垫。使用视觉模拟量表（0至10分，10分为最高舒适度）评估行走舒适度。
与未增强的鞋相比，增强鞋的跖骨头峰值压力显著降低（中位数降低10至22千帕）（p <.001）。在使用增强鞋的病例中，超过83%以及使用未增强鞋的病例中超过71%的跖骨头峰值压力<200千帕。在后足部位，增强鞋的峰值压力显著更高（中位数高24千帕）（p =.001）。在脚趾部位未发现显著的鞋类效应。在行走舒适度方面未发现显著的鞋类效应：增强鞋的中位数为6.1，未增强鞋的中位数为5.6。
在糖尿病专用鞋的外底添加全长碳增强材料可显著降低糖尿病高风险患者跖骨头处（溃疡常发生部位）的峰值压力，且不会以患者感知的行走舒适度为代价。
