Non-surgical offloading in diabetic foot syndrome

Abstract

The aim of the thesis was to investigate the effect of early weightbearing in the treatment of Charcot neuroarthropathy on the incidence of ulcers and amputation. Furthermore, the aim was to investigate which type(s) of materials and material combinations used in custom insoles offer the best offloading properties and longevity. The first study was a retrospective cohort study investigating the incidence of ulcers and amputation after treatment of acute Charcot neuroarthropathy with early weightbearing in a Charcot Restraint Orthotic Walker. A high incidence of both ulcers and amputations was found after employing this treatment. Hindfoot manifestation increased the risk of amputation, but not the incidence of ulcers. The second study was a systematic review of the litterature pertaining to the offloading effect of different materials and material combinations used in custom offloading insoles. No metaanalysis of the data was possible, resulting in no clear conclusion on which materials were superior, but rather some recommendations could be made. When constructing single material custom insoles, moderately deformable materials should be preferred. If softer materials are chosen one should consider increasing the thickness of the insole to improve offloading and longevity. Custom insoles combining materials of different properties may be better in regards to both offloading effect and longevity. The last study was a prospective cohort study investigating the effect of custom insoles produced in one single and a combination of materials on both the offloading effect and longevity. The study found that the insole made of a combination of materials was best at both immediate offloading and longevity, but at the end of the testperiod none of the insoles offered significant reduction of pressure compared to baseline.