Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity

Sicco A. Bus, Jan S. Ulbrecht, Peter R. Cavanagh

Research output: Contribution to journalArticlepeer-review

211 Scopus citations


Objective. To study the effects of custom-made insoles on plantar pressures and load redistribution in neuropathic diabetic patients with foot deformity. Design. Cross-sectional. Background. Although custom-made insoles are commonly prescribed to diabetic patients, little quantitative data on their mechanical action exists. Methods. Regional in-shoe peak pressures and force-time integrals were measured during walking in the feet of 20 neuropathic diabetic subjects with foot deformity who wore flat or custom-made insoles. Twenty-one feet with elevated risk for ulceration at the first metatarsal head were analysed. Load redistribution resulting from custom-made insoles was assessed using a new load-transfer algorithm. Results. Custom-made insoles significantly reduced peak pressures and force-time integrals in the heel and first metatarsal head regions; pressures and integrals were significantly increased in the medial midfoot region compared with flat insoles. Custom-made insoles successfully reduced pressures in and integrals at the first metatarsal head in 7/21 feet, were moderately successful in another seven, but failed in the remaining seven. Load transfer was greatest from the lateral heel to the medial midfoot regions. Conclusions. Custom-made insoles were more effective than flat insoles in off-loading the first metatarsal head region, but with considerable variability between individuals. Most off-loading occurred in the heel (not a region typically at risk). The load transfer algorithm effectively analyses custom-made-insole action.Relevance Because similar insole modifications apparently exert different effects in different patients, a comprehensive evaluation of custom designs using in-shoe pressure measurement should ideally be conducted before dispensing insoles to diabetic patients with neuropathy and foot deformity.

Original languageEnglish (US)
Pages (from-to)629-638
Number of pages10
JournalClinical Biomechanics
Issue number6
StatePublished - Jul 2004

All Science Journal Classification (ASJC) codes

  • Biophysics
  • Orthopedics and Sports Medicine


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