The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: A systematic review

Diabetes/Metabolism Research and Reviews

Volumn 24, Issue SUPPL. 1, 2008, Pages

  Bus, Sicco A ^a   Valk, G D ^b   van Deursen, R W ^c   Armstrong, D G ^d   Caravaggi, C ^e   Hlavacek P ^f   Bakker, K ^g   Cavanagh, P R ^h  

^a UNIVERSITY OF AMSTERDAM   (Netherlands)

^b UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

^c CARDIFF UNIVERSITY   (United Kingdom)

^d ROSALIND FRANKLIN UNIVERSITY OF MEDICINE AND SCIENCE   (United States)

^e VITA SALUTE SAN RAFFAELE UNIVERSITY   (Italy)

^f TOMAS BATA UNIVERSITY IN ZLIN   (Czech Republic)

^g IWGDF   (Netherlands)

^h LERNER RESEARCH INSTITUTE   (United States)

Author keywords

Diabetes; Diabetic foot; Footwear; Offloading; Plantar pressure; Ulcer

Indexed keywords

ACHILLES TENDON LENGTHENING; BONE RESECTION; CAST APPLICATION; CLINICAL EFFECTIVENESS; CLINICAL TRIAL; CONFERENCE PAPER; DIABETES MELLITUS; DIABETIC FOOT; EVIDENCE BASED PRACTICE; FOOT CARE; FOOT ULCER; HUMAN; ORTHOPEDIC SHOE; PLANTAR PRESSURE REDUCTION; PRIORITY JOURNAL; PUBLICATION; SURGICAL TECHNIQUE; SYSTEMATIC REVIEW; TENDON SURGERY; ULCER HEALING; WALKING AID;

DIABETES MELLITUS, TYPE 1; DIABETES MELLITUS, TYPE 2; DIABETIC FOOT; FOOT ULCER; HUMANS; PRESSURE; REFLEX, BABINSKI; SHOES; WEIGHT-BEARING;

EID: 44949163756     PISSN: 15207552     EISSN: 15207560     Source Type: Journal    
DOI: 10.1002/dmrr.850     Document Type: Conference Paper

References (116)

1. Maciejewski ML, Reiber GE, Smith DG, Wallace C, Hayes S, Boyko EJ. Effectiveness of diabetic therapeutic footwear in preventing reulceration. Diabetes Care 2004; 27: 1774-1782.
2. Reiber GE, Smith DG, Wallace C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA 2002; 287: 2552-2558.
3. Cavanagh PR, Boulton AJ, Sheehan P, Ulbrecht JS, Caputo GM, Armstrong DG. Therapeutic footwear in patients with diabetes. JAMA 2002; 288: 1231-1233, Author reply: 1232-3.
4. Chantelau E. Therapeutic footwear in patients with diabetes. JAMA 2002; 288: 1231-1232, Author reply: 1232-3.
5. Uccioli L, Faglia E, Monticone G, et al. Manufactured shoes in the prevention of diabetic foot ulcers. Diabetes Care 1995; 18: 1376-1378.
6. Litzelman DK, Marriott DJ, Vinicor F. The role of footwear in the prevention of foot lesions in patients with NIDDM. Conventional wisdom or evidence-based practice? Diabetes Care 1997; 20: 156-162.
7. Dargis V, Pantelejeva O, Jonushaite A, Vileikyte L, Boulton AJ. Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study. Diabetes Care 1999; 22: 1428-1431.
8. Viswanathan V, Madhavan S, Gnanasundaram S, et al. Effectiveness of different types of footwear insoles for the diabetic neuropathic foot: a follow-up study. Diabetes Care 2004; 27: 474-477.
9. Striesow F. Special manufactured shoes for prevention of recurrent ulcer in diabetic foot syndrome. Med Klin (Munich) 1998; 93: 695-700.
10. Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE. Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am 2003; 85-A: 1436-1445.
11. Piaggesi A, Schipani E, Campi F, et al. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial. Diabet Med 1998; 15: 412-417.
12. Armstrong DG, Lavery LA, Vazquez JR, et al. Clinical efficacy of the first metatarsophalangeal joint arthroplasty as a curative procedure for hallux interphalangeal joint wounds in patients with diabetes. Diabetes Care 2003; 26: 3284-3287.
13. Armstrong DG, Rosales MA, Gashi A. Efficacy of fifth metatarsal head resection for treatment of chronic diabetic foot ulceration. J Am Podiatr Med Assoc 2005; 95: 353-356.
14. Mueller MJ, Diamond JE, Sinacore DR, et al. Total contact casting in treatment of diabetic plantar ulcers. Controlled clinical trial. Diabetes Care 1989; 12: 384-388.
15. Caravaggi C, Faglia E, De GR, et al. Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care 2000; 23: 1746-1751.
16. Armstrong DG, Nguyen HC, Lavery LA, Van Schie CHM, Boulton AJM, Harkless LB. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 2001; 24: 1019-1022.
17. Ha Van G, Siney H, Hartmann-Heurtier A, Jacqueminet S, Greau F, Grimaldi A. Nonremovable, windowed, fiberglass cast boot in the treatment of diabetic plantar ulcers: efficacy, safety, and compliance. Diabetes Care 2003; 26: 2848-2852.
18. Agas CM, Bui TD, Driver VR, Gordon IL. Effect of window casts on healing rates of diabetic foot ulcers. J Wound Care 2006; 15: 80-83.
19. Wukich DK, Motko J. Safety of total contact casting in high-risk patients with neuropathic foot ulcers. Foot Ankle Int 2004; 25: 556-560.
20. Armstrong DG, Lavery LA, Bushman TR. Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts. J Rehabil Res Dev 1998; 35: 1-5.
21. Birke JA, Novick A, Patout CA, Coleman WC. Healing rates of plantar ulcers in leprosy and diabetes. Lepr Rev 1992; 63: 365-374.
22. Birke JA, Novick A, Graham SL, Coleman WC, Brasseaux DM. Methods of treating plantar ulcers. Phys Ther 1991; 71: 116-122.
23. Birke JA, Pavich MA, Patout CA Jr, Horswell R. Comparison of forefoot ulcer healing using alternative off-loading methods in patients with diabetes mellitus. Adv Skin Wound Care 2002; 15: 210-215.
24. Borssen B, Lithner F. Plaster casts in the management of advanced ischaemic and neuropathic diabetic foot lesions. Diabet Med 1989; 6: 720-723.
25. Boulton AJ, Bowker JH, Gadia M, et al. Use of plaster casts in the management of diabetic neuropathic foot ulcers. Diabetes Care 1986; 9: 149-152.
26. Nabuurs-Franssen MH, Huijberts MS, Sleegers R, Schaper NC. Casting of recurrent diabetic foot ulcers: effective and safe? Diabetes Care 2005; 28: 1493-1494.
27. Nabuurs-Franssen MH, Sleegers R, Huijberts MS, et al. Total contact casting of the diabetic foot in daily practice: a prospective follow-up study. Diabetes Care 2005; 28: 243-247.
28. Saltzman CL, Zimmerman MB, Holdsworth RL, Beek S, Hartsell HD, Frantz RA. Effect of initial weight-bearing in a total contact cast on healing of diabetic foot ulcers. J Bone Joint Surg Am 2004; 86-A: 2714-2719.
29. Sinacore DR, Mueller MJ, Diamond JE, Blair VP III, Drury D, Rose SJ. Diabetic plantar ulcers treated by total contact casting. A clinical report. Phys Ther 1987; 67: 1543-1549.
30. Tamir E, Heim M, Siev-Ner I. Removable fiberglass de-loading cast for the management of neuropathic plantar ulceration of the foot. Isr Med Assoc J 2005; 7: 507-510.
31. Fejfarova V, Jirkovska A, Krizova M, Skibova J. The effect of removable total contact cast therapy on healing of patients with diabetic foot ulcers, acute Charcot osteoarthropathy and neuropathic fractures. Vnitr Lek 2005; 51 (9): 988-994.
32. Hissink RJ, Manning HA, van Baal JG. The MABAL shoe, an alternative method in contact casting for the treatment of neuropathic diabetic foot ulcers. Foot Ankle Int 2000; 21: 320-323.
33. Hollander MR, Holton K, Mader D. Total contact povidone-iodine perfusion cast for the treatment of neuropathic ulcers. J Foot Surg 1986; 25: 484-488.
34. Huband MS, Carr JB. A simplified method of total contact casting for diabetic foot ulcers. Contemp Orthop 1993; 26: 143-147.
35. Lin SS, Lee TH, Wapner RL. Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting. Orthopedics 1996; 19: 465-475.
36. Lin SS, Bono CM, Lee TH. Total contact casting and Keller arthoplasty for diabetic great toe ulceration under the interphalangeal joint. Foot Ankle Int 2000; 21: 588-593.
37. Matricali GA. Deroo K, Dereymaeker G. Outcome and recurrence rate of diabetic foot ulcers treated by a total contact cast: short-term follow-up. Foot Ankle Int 2003; 24: 680-684.
38. Mueller MJ, Smith KE, Commean PK, Robertson DD, Johnson JE. Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes. Phys Ther 1999; 79: 296-307.
39. Walker SC, Helm PA, Pullium G. Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Arch Phys Med Rehabil 1987; 68: 217-221.
40. Knowles EA, Armstrong DG, Hayat SA, Khawaja KI, Malik RA, Boulton AJ. Offloading diabetic foot wounds using the scotchcast boot: a retrospective study. Ostomy Wound Manage 2002; 48: 50-53.
41. Boninger ML, Leonard JA Jr. Use of bivalved ankle-foot orthosis in neuropathic foot an ankle lesions. J Rehabil Res Dev 1996; 33: 16-22.
42. Maland E, Walker C, Dalton J. Use of an EVA boot in a patient with a foot ulcer. J Wound Care 1997; 6: 319-320.
43. Singleton EE, Cotton RS, Shelman HS, Another approach to the long-term management of the diabetic neurotrophic foot ulcer. J Am Podiatry Assoc 1978; 68: 242-244.
44. Downs DM, Jacobs RL. Treatment of resistant ulcers on the plantar surface of the great toe in diabetics. J Bone Joint Surg Am 1982; 64: 930-933.
45. Davies S, Gibby O, Phillips C, Price P, Tyrrell W. The health status of diabetic patients receiving orthotic therapy. Qual Life Res 2000; 9: 233-240.
46. Holstein P, Larsen K, Sager P. Decompression with the aid of insoles in the treatment of diabetic neuropathic ulcers. Acta Orthop Scand 1976; 47: 463-468.
47. Larsen K, Fabrin J, Holstein PE. Incidence and management of ulcers in diabetic Charcot feet. J Wound Care 2001; 10: 323-328.
48. Chantelau E, Breuer U, Leisch AC, Tanudjaja T, Reuter M. Outpatient treatment of unilateral diabotic foot ulcers with 'half shoes'. Diabet Med 1993; 10: 267-270.
49. Chantelau E, Haage P. An audit of cushioned diabetic footwear: relation to patient compliance. Diabet Med 1994; 11: 114-116.
50. Giurini JM, Basile P, Chrzan JS, Habershaw GM, Rosenblum BI. Panmetatarsal head section. A viable alternative to the transmetatarsal amputation. J Am Podiatr Med Assoc 1993; 83: 101-117.
51. Rosenblum BI, Giurini JM, Chrzan JS, Habershaw GM. Preventing loss of the great toe with the hallux interphalangeal joint arthroplasty. J Foot Ankle Surg 1994; 33: 557-560.
52. Petrov O, Pfeifer M, Flood M, Chagares W, Daniele C. Recurrent plantar ulceration following pan metatarsal head resection. J Foot Ankle Surg 1996; 35: 573-577.
53. Patel VG, Wieman TJ. Effect of metatarsal head resection for diabetic foot ulcers on the dynamic plantar pressure distribution. Am J Surg 1994; 167: 297-301.
54. Early JS, Hansen ST. Surgical reconstruction of the diabetic foot: a salvage approach for midfoot collapse. Foot Ankle Int 1996; 17: 325-330.
55. Crandall RC, Wagner FW Jr. Partial and total calcanectomy. A review of thirty-one consecutive cases over a ten-year period. J Bone Joint Surg Am 1981; 63: 152-155.
56. Farber DC, Juliano PJ, Cavanagh PR, Ulbrecht J. Caputo G. Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy. Foot Ankle Int 2002; 23: 130-134.
57. Fleischli JE, Anderson RB, Davis WH, Kiebzak GM. Dorsiflexion metatarsal osteotomy for treatment of recalcitrant diabetic neuropathic ulcers. Foot Ank Int 1999; 20: 80-85.
58. Brodsky JW, Rouse AM. Exostectomy for symptomatic bony prominences in diabetic charcot feet. Clin Orthop Relat Res 1993; 296: 21-26.
59. Catanzariti AR, Mendicino R, Haverstock B. Ostectomy for diabetic neuroarthropathy involving the midfoot. J Foot Ankle Surg 2000; 39: 291-300.
60. Tillo TH, Giurini JM, Habershaw GM, Chrzan JS, Rowbotham JL. Review of metatarsal osteotomies for the treatment of neuropathic ulcerations. J Am Podiatr Med Assoc 1990; 80: 211-217.
61. Altindas M, Cinar C. Promoting primary healing after ray amputations in the diabetic foot: the plantar dermo-fat pad flap. Plast Reconstr Surg 2005; 116: 1029-1034.
62. Balkin SW. The fluid silicon prosthesis. Clin Podiatry 1984; 1: 145-164.
63. Cohn BT, Brahms MA. Diabetic arthropathy of the first metatarsal cuneiform joint. Introduction of a new surgical fusion technique. Orthop Rev 1987; 16: 465-470.
64. Cooper PS. Application of external fixators for management of Charcot deformities of the foot and ankle. Semin Vasc Surg 2003; 16: 67-78.
65. Frykberg RG, Piaggesi A, Donaghue VM, et al. Difference in treatment of foot ulcerations in Boston, USA and Pisa, Italy. Diabetes Res Clin Pract 1997; 35: 21-26.
66. Giacalone VF, Krych SM, Harkless LB. The University of Texas Health Science Center at San Antonio: experience with foot surgery in diabetics. J Foot Ankle Surg 1994; 33: 590-597.
67. Hamilton GA, Ford LA, Perez H, Rush SM. Salvage of the neuropathic foot by using bone resection and tendon balancing: a retrospective review of 10 patients. J Foot Ankle Surg 2005; 44: 37-43.
68. Holstein P, Lohmann M, Bitsch M, Jorgensen B. Achilles tendon lengthening, the panacea for plantar forefoot ulceration? Diabetes Metab Res Rev 2004; 20: S37-S40.
69. Jarde O, Filloux V, Filloux JF, Remond A, Vives P. M.R.I. and surgical indications in perforating ulcer of the foot in diabetic patients. Acta Orthop Belg 1997; 63: 156-164.
70. Oznur A. Management of large soft-tissue defects in a diabetic patient. Foot Ankle Int 2003; 24: 79-82.
71. Oznur A, Tokgozoglu M. Closure of central defects of the forefoot with external fixation: a case report. J Foot Ankle Surg 2004; 43: 56-59.
72. Perez ML, Wagner SS, Yun J. Subtotal calcanectomy for chronic heel ulceration. J Foot Ankle Surg 1994; 33: 572-579.
73. Reimer H, Ketfi M, Boulmont M. Diabetic foot: is preventive surgery possible? Zentralbl Chir 1999; 124: S33-S35.
74. Ris HB, Reber P. Preservation of the first ray in a diabetic patient with a penetrating ulcer and arterial insufficiency by use of debridement and external fixation. Eur J Vasc Surg 1994; 8: 514-516.
75. Wray CC. The Helal osteotomy in a diabetic patient. Pract Diabetes Int 1986; 3: 156.
76. Wieman TJ, Mercke YK, Cerrito PB, Taber SW. Resection of the metatarsal head for diabetic foot ulcers. Am J Surg 1998; 176: 436-441.
77. Smith WJ, Jacobs RL, Fuchs MD. Salvage of the diabetic foot with exposed os calcis. Clin Orthop Relat Res 1993; 296: 71-77.
78. Sage RA, Webster JK, Fisher SG. Outpatient care and morbidity reduction in diabetic foot ulcers associated with chronic pressure callus. J Am Podiatr Med Assoc 2001; 91: 275-279.
79. Rosenblum BI, Giurini JM, Miller LB, Chrzan JS, Habershaw GM. Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage. J Foot Ankle Surg 1997; 36: 360-363.
80. Armstrong DG, Lavery LA, Wu S, Boulton AJM. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 2005; 28: 551-554.
81. Katz IA, Harlan A, Miranda-Palma B, et al. A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care 2005; 28: 555-559.
82. Zimny S, Schatz H, Pfohl U. The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers. Diabet Med 2003; 20: 622-625.
83. Black JR. Management of diabetic plantar ulcers with a walking brace. a clinical trial. J Am Podiatr Med Assoc 1990; 80: 156-157.
84. Ritz G, Rowland WD, Rowland JW. Use of the Cam Walker in treating diabetic ulcers. A case report. J Am Podiatr Med Assoc 1996; 86: 253-256.
85. Landsman AS, Sage R. Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis. J Am Podiatr Med Assoc 1997, 87: 349-357.
86. Armstrong DG, Stacpoole-Shea S. Total contact casts and removable cast walkers. Mitigation of plantar heel pressure. J Am Podiatr Med Assoc 1999; 89: 50-53.
87. Fleischli JG, Lavery LA, Vela SA, Ashry H, Lavery DC, William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers. J Am Podiatr Med Assoc 1997; 87: 466-472.
88. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL. Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. A comparison of treatments. Diabetes Care 1996; 19: 818-821.
89. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL. Total contact casts: pressure reduction at ulcer sites and the effect on the contralateral foot. Arch Phys Med Rehabil 1997; 78: 1268-1271.
90. Martin RL, Conti SF. Plantar pressure analysis of diabetic rockerbottom deformity in total contact casts. Foot Ankle Int 1996; 17: 470-472.
91. Praet SF, Louwerens JW. The influence of shoe design on plantar pressures in neuropathic feet. Diabetes Care 2003; 26: 441-445.
92. Albert S, Rinoie C. Effect of custom orthotics on plantar pressure distribution in the pronated diabetic foot. J Foot Ankle Surg 1994; 33: 598-604.
93. Ashry HR, Lavery LA, Murdoch DP, Frolich M, Lavery DC. Effectiveness of diabetic insoles to reduce foot pressures. J Foot Ankle Surg 1997; 36: 268-271.
94. Bus SA, Ulbrecht JS, Cavanagh PR. Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity. Clin Biomech (Bristol, Avon) 2004; 19: 629-638.
95. Duffin AC, Kidd R, Chan A, Donaghue KC. High plantar pressure and callus in diabetic adolescents. Incidence and treatment. J Am Podiatr Med Assoc 2003; 93: 214-220.
96. Kastenbauer T, Sokol G, Auinger M, Irsigler K. Running shoes for relief of plantar pressure in diabetic patients. Diabet Med 1998; 15: 518-522.
97. Kato H, Takada T, Kawamura T, Hotta N, Torii S. The reduction and redistribution of plantar pressures using foot orthoses in diabetic patients. Diabetes Res Clin Pract 1996; 31: 115-118.
98. Lavery LA, Vela SA, Fleischli JG, Armstrong DG, Lavery DC. Reducing plantar pressure in the neuropathic foot. A comparison of footwear. Diabetes Care 1997; 20: 1706-1710.
99. Lord M, Hosein R. Pressure redistribution by molded inserts in diabetic footwear: a pilot study. J Rehabil Res Dev 1994; 31: 214-221.
100. Perry JE, Ulbrecht JS, Derr JA, Cavanagh PR. The use of running shoes to reduce plantar pressures in patients who have diabetes. J Bone Joint Surg Am 1995; 77: 1819-1828.
101. Raspovic A, Newcombe L, Lloyd J, Dalton E. Effect of customized insoles on vertical plantar pressures in sites of previous neuropathic ulceration in the diabetic foot. Foot 2000; 10: 133-138.
102. Tsung BYS, Zhang M, Mak AFT, Wong MWN. Effectiveness of insoles on plantar pressure redistribution. J Rehabil Res Dev 2004, 41: 767-774.
103. van Schie CH, Whalley A, Armstrong DG, Vileikyte L, Boulton AJ. The effect of silicone injections in the diabetic foot on peak plantar pressure and plantar tissue thickness: a 2-year follow-up. Arch Phys Med Rehabil 2002; 83: 919-923.
104. Maluf KS, Mueller MJ, Strube MJ, Engsberg JR, Johnson JE. Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait. J Biomech 2004; 37: 897-906.
105. Armstrong DG, Stacpoole-Shea S, Nguyen H, Harkless LB. Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J Bone Joint Surg Am 1999; 81: 535-538.
106. Cavanagh PR, Ulbrecht JS, Caputo GM. Elevated plantar pressure and ulceration in diabetic patients after panmetatarsal head resection: two case reports. Foot Ankle Int 1999; 20: 521-526.
107. Garbalosa JC, Cavanagh PR, Wu G, et al. Foot function in diabetic patients after partial amputation. Foot Ankle Int 1996; 17: 43-48.
108. Pitei DL, Foster A, Edmonds M. The effect of regular callus removal on foot pressures. J Foot Ankle Surg 1999; 38: 251-255.
109. Young MJ, Cavanagh PR, Thomas G, Johnson MM, Murray H, Boulton AJ. The effect of callus removal on dynamic plantar foot pressures in diabetic patients. Diabet Med 1992; 9: 55-57.
110. Piaggesi A, Romanelli M, Fallani E, Baccetti F, Navalesi R. Polyurethane foam sheets for relieving pressure from diabetic neuropathic plantar ulcers: A pilot study. J Dermatolog Treat 2000; 11: 39-42.
111. Mueller MJ, Sinacore DR, Hastings MK, Lott DJ, Strube MJ, Johnson JE. Impact of achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic plantar ulcer. Diabetes Care 2004; 27: 1559-1564.
112. Salsich GB, Mueller MJ, Hastings MK, Sinacore DR, Strube MJ, Johnson JE. Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther 2005; 85: 34-43.
113. Knowles EA, Boulton AJM. Do people with diabetes wear their prescribed footwear? Diabet Med 1996; 13: 1064-1068.
114. Armstrong DG, Lavery LA, Kimbriel HR, Nixon BP, Boulton AJ. Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen. Diabetes Care 2003; 26: 2595-2597.
115. Williams AE, Nester CJ. Patient perceptions of stock footwear design features. Prosthet Orthot Int 2006; 30: 61-71.
116. Matricali GA, Dereymaeker G, Muls E, Flour M, Mathieu C. Economic aspects of diabetic foot care in a multidisciplinary setting: a review. Diabetes Metab Res Rev 2006; 23: 339-347.