The Best Offloading Device: It's the one you wear!

Despite the prevalence for recurrent foot ulcers in patients with diabetes, adherence has remained a problem. According to researchers in the Netherlands, this adherence is poorer at home, where patients tend to walk most often.

“Patient self-report studies show that only 22% to 36% of diabetic patients withperipheral neuropathy, vascular disease, or foot deformity wear prescription footwear regularly (>80% of the day),” researchers wrote. “This is unfortunate, since it has been shown that ulcer recurrence rate can be substantially reduced when patients adhere to wearing pressure-relieving footwear.”

The researchers examined 107 patients withdiabetes, neuropathy, a recently healed plantar foot ulcer and custom-made footwear. During 7 consecutive days using a shoe-worn, temperature-based monitor, the researchers measured footwear use. Researchers wrote that daily step counts were measured simultaneously using an activity monitor worn on the patients’ ankle. Self-reported time from home was conducted by patients and adherence was measured by the percentage of steps the monitor recorded.

The patients wore prescribed footwear 6.4 hours per day at home and 3.5 hours per day away from home.

The researchers discovered mean adherence was about 71%. However, the adherence from home was 61%, at over 3,959 steps. Adherence away from home measured 87%, at over 2,604 steps, they wrote. Of 35 patients with low adherence (<60%), adherence at home was 28%.

“When patients were at home, adherence was significantly lower than when away from home (P<.001), while daily step count was significantly higher at home (P<.001),” the researchers wrote.

These findings show that adherence to prescribed custom-made footwear is not sufficient at home, among patients with diabetes and neuropathy, and researchers suggest adherence improvements to decrease the risk for reulceration.

Disclosure: The researchers report no relevant financial disclosures