Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration

Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration Matthew L. Maciejewski , PHD 1 2 , Gayle E. Reiber , MPH, PHD 1 2 3 4 5 , Douglas G. Smith , MD 6 , Carolyn Wallace , PHD 1 , Shane Hayes , CPED 1 and Edward J. Boyko , MD 1 4 5 7 1 Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington 2 Department of Health Services, University of Washington, Seattle, Washington 3 Rehabilitation Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington 4 Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington 5 Department of Epidemiology, University of Washington, Seattle, Washington 6 Department of Orthopedic Surgery, University of Washington, Seattle, Washington 7 Department of Medicine, University of Washington, Seattle, Washington Address correspondence and reprint requests to Matthew L. Maciejewski, PhD, VA Puget Sound Health Care System (HSR&D 152), 1660 S. Columbian Way, Seattle, WA 98108. E-mail: mlmaciej{at}u.washington.edu Abstract OBJECTIVE —To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors. RESEARCH DESIGN AND METHODS —We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study population, components of the intervention, and level of adherence were evaluated. U.S. Preventive Services Task Force criteria for evaluating research were applied to rate each study on study design and internal validity. RESULTS —Risk ratios in all studies assessing the association between therapeutic footwear and reulceration were below 1.0, suggesting some protective footwear benefit. However, in the most rigorous experimental study, no statistically significant benefit was observed between control patients wearing their own footwear and intervention patients wearing study footwear. Annual reulceration in these studies’ control groups ranged from 8.4 to 59.3%. In patients with severe foot deformity or prior toe or ray amputation, observational studies suggested a significant protective benefit from therapeutic footwear. CONCLUSIONS —Therapeutic footwear has been used for decades as one of many