Effectiveness of Shoes and Total Contact Foot Orthotics in Diabetic Patients at High risk of Foot Ulceration
Keywords:
diabetic foot ulcer, shoes, total contact foot orthoticsAbstract
Objective : The aim was to study the effectiveness of preventing an occurrence of recurrent ulcers and analyzing factors affecting that ulcers after receiving the shoes and total contact foot orthotics (TCFOs) in diabetic patients at high risk of foot ulceration .
Method :The study method was to follow up diabetic patients who were at high risk of foot ulceration ( neuropathic ulcer ) and received TCFOs alone or shoes with TCFOs from the Prosthetics and Orthotics Unit Division of Rehabilitation Medicine , Ratchaburi Hospital from January 2016 – June 2018. These patients were followed for at least 6 months after receiving the footwears. The data obtained included personal information, foot deformity, body mass index (BMI), , average fasting blood sugar (FBS) level, wearing or not wearing footwears, an occurrence rate of recurrent ulcers and analyzing factors affecting the occurrence of recurrent ulcers
Result : There were 48 patients aged between 34-81 years old (average, 59.31± 10.43 years old) participated in the study. Most patients were men (54.2%). The average duration of having diabetes was 13.73±9.60 years. Their average FBS and BMI were 146.77±47.85 mg/dl and 27.48±4.34 kg/m2, respectively. Twenty-two patients (45.8%) had foot deformity. Twenty-eight patients (58.3%) already had foot ulcers at the time of obtaining shoes and fourteen patients (29.2%) had at least one toe amputated. The average length of follow up was 10.51±6.37 months. Thirty-five cases (72.9%) received both shoes and TCFOs , thirteen cases (27.1%) received only TCFOs. The occurrence of recurrent ulcers was noted in six cases (12.5%). Odds ratio and 95% confidence interval revealed that factors about diabetic duration ( ≥ 10 years) , not strict glycemic control ( FBS ≥ 141 mg/dl ) , overweight ( BMI ≥ 25) and “not wearing footwear ” did not significantly affect the occurrence of recurrent ulcers
Conclusion : The occurrence of recurrent ulcers in diabetic patients who are at risk of foot ulceration after receiving shoes and TCFOs is 12.5 % . Factors about diabetic duration ( ≥ 10 years) , not strict glycemic control (FBS ≥ 141 mg/dl) , overweight ( BMI ≥ 25) and “not wearing footwear ” did not significantly affect the occurrence of recurrent ulcers .
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