The effectiveness of footwear as an intervention to prevent or to reduce biomechanical risk factors associated with diabetic foot ulceration: A systematic review

Aim: Footwear interventions are used within clinical practice in an effort to reduce ulcerations however the effectiveness of these interventions is unclear. The aim of this paper was to conduct a systematic review which examined the effectiveness of footwear as an intervention for prevention of diabetic foot ulcers or the reduction of biomechanical risk factors for ulceration and to discuss the quality and interpret the findings of research to date. Methods: The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with 12 articles identified for review. Results: The majority of these studies were cross sectional and examined the effect of different footwear conditions on plantar pressure measurements. Factors which influenced study findings such as participant selection, measurement and analysis techniques, footwear design and compliance are discussed and recommendations for future studies are provided. Conclusions: No research to date has examined the effectiveness of footwear in preventing ulceration. Conflicting findings are reported on the effective of footwear interventions to prevent reulceration. While the use of rocker sole footwear and custom orthoses in plantar pressure reduction are supported in cross sectional studies, longitudinal studies are required to confirm their benefit. (C) 2013 Elsevier Inc. All rights reserved.