Evidence for orthotic treatment of the low risk diabetic foot

Warning

No risk factors present: e.g. no loss of sensation, no signs of peripheral arterial disease and no other risk factors

(Categories per the Scottish Foot Action Group, relating to the use of the SCI-Diabetes foot risk stratification tool)

Patient education / Footwear advice

Meta-Analyses

Adiewere, P., Gillis, R.B., Jiwani, S.I., Meal, A., Shaw, I. and Adams, G.G., 2018. A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU). Heliyon, 4(5), p.e00614.
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Fu, X.L., Ding, H., Miao, W.W. and Chen, H.L., 2018. Association between cigarette smoking and diabetic foot healing: a systematic review and meta-analysis. The international journal of lower extremity wounds, 17(4), pp.247-257.
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Rigato, M., Pizzol, D., Tiago, A., Putoto, G., Avogaro, A. and Fadini, G.P., 2018. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes research and clinical practice.
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Systematic Reviews

Ahmad Sharoni, S.K., Minhat, H.S., Mohd Zulkefli, N.A. and Baharom, A., 2016. Health education programmes to improve foot self‐care practices and foot problems among older people with diabetes: a systematic review. International journal of older people nursing, 11(3), pp.214-239.
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Binning, J., Woodburn, J., Bus, S.A. and Barn, R., 2018. Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration. Diabetes/metabolism research and reviews, p.e3105.
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Bonner, T., Foster, M. and Spears-Lanoix, E., 2016. Type 2 diabetes–related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature. Diabetic foot & ankle, 7(1), p.29758.
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Dinh, T.T.H., Bonner, A., Clark, R., Ramsbotham, J. and Hines, S., 2016. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI database of systematic reviews and implementation reports, 14(1), pp.210-247.
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Dorresteijn, J.A., Kriegsman, D.M., Assendelft, W.J. and Valk, G.D., 2012. Patient education for preventing diabetic foot ulceration. Cochrane database of systematic reviews, (10).
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Matricciani, L. and Jones, S., 2015. Who cares about foot care? Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: an integrative review. The Diabetes Educator, 41(1), pp.106-117.
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Morey-Vargas, O.L. and Smith, S.A., 2015. BE SMART: strategies for foot care and prevention of foot complications in patients with diabetes. Prosthetics and orthotics international, 39(1), pp.48-60.
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Navarro-Flores, E., Gijón-Noguerón, G., Cervera-Marín, J.A. and Labajos-Manzanares, M.T., 2015. Assessment of foot self-care in patients with diabetes: retrospective assessment (2008-2014). Foot & ankle specialist, 8(5), pp.406-412.
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Van Netten, J.J., Price, P.E., Lavery, L.A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y., Bus, S.A. and International Working Group on the Diabetic Foot (IWGDF), 2016. Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review. Diabetes/metabolism research and reviews, 32, pp.84-98.
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van Netten, J.J., Sacco, I.C., Lavery, L.A., Monteiro‐Soares, M., Rasmussen, A., Raspovic, A. and Bus, S.A., 2020. Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review. Diabetes/Metabolism Research and Reviews, p.e3271.
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Interventional Studies

Cisneros, L.L., 2010. Evaluation of a neuropathic ulcers prevention program for patients with diabetes. Brazilian Journal of Physical Therapy, 14(1), pp.31-37.
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Corbett, C.F., 2003. A randomized pilot study of improving foot care in home health patients with diabetes. The Diabetes Educator, 29(2), pp.273-282.
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Gershater, A.M., Pilhammar, E., Apelqvist, J. and Alm-roijer, C., 2011. patient education for the prevention of diabetic foot ulcers: interim analysis of a randomised controlled trial due to morbidity and mortality of participants. European Diabetes Nursing, 8(3), pp.102-107b.
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Keukenkamp, R., Merkx, M.J., Busch-Westbroek, T.E. and Bus, S.A., 2018. An Explorative Study on the Efficacy and Feasibility of the Use of Motivational Interviewing to Improve Footwear Adherence in Persons with Diabetes at High Risk for Foot Ulceration. Journal of the American Podiatric Medical Association, 108(2), p.90.
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Lincoln, N.B., Radford, K.A., Game, F.L. and Jeffcoate, W.J., 2008. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia, 51(11), p.1954.
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McBride, E., Hacking, B., O'Carroll, R., Young, M., Jahr, J., Borthwick, C., Callander, A. and Berrada, Z., 2016. Increasing patient involvement in the diabetic foot pathway: a pilot randomized controlled trial. Diabetic Medicine, 33(11), pp.1483-1492.
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McMurray, S.D., Johnson, G., Davis, S. and McDougall, K., 2002. Diabetes education and care management significantly improve patient outcomes in the dialysis unit. American journal of kidney diseases, 40(3), pp.566-575.
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Monami, M., Zannoni, S., Gaias, M., Nreu, B., Marchionni, N. and Mannucci, E., 2015. Effects of a short educational program for the prevention of foot ulcers in high-risk patients: A randomized controlled trial. International journal of endocrinology, 2015.
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Sartor, C.D., Hasue, R.H., Cacciari, L.P., Butugan, M.K., Watari, R., Pássaro, A.C., Giacomozzi, C. and Sacco, I.C., 2014. Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial. BMC musculoskeletal disorders, 15(1), p.137.
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Sharoni, S.K.A., Rahman, H.A., Minhat, H.S., Shariff-Ghazali, S. and Ong, M.H.A., 2018. The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PloS one, 13(3), p.e0192417.
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Observational Studies

Barwick, A.L., Hurn, S.E., van Netten, J.J., Reed, L.F. and Lazzarini, P.A., 2019. Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study. PloS one, 14(2).
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Nemcová, J. and Hlinková, E., 2014. The efficacy of diabetic foot care education. Journal of clinical nursing, 23(5-6), pp.877-882.
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Nongmaithem, M., Bawa, A.P.S., Pithwa, A.K., Bhatia, S.K., Singh, G. and Gooptu, S., 2016. A study of risk factors and foot care behavior among diabetics. Journal of family medicine and primary care, 5(2), p.399.
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Rojas-Torres, F., Infanzón-Talango, H., García-Ulloa, A.C., Hernández-Jiménez, S. and Rodríguez-Reyes, G., 2024. Exploring plantar pressure distribution in patients with newly diagnosed diabetes: Implications for foot ulcer prevention in an overweight Mexican population. Endocrinología, Diabetes y Nutrición, 71(8), pp.340-347.
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Narrative Literature Reviews

Bullen, B., Young, M., McArdle, C. and Ellis, M., 2019. Overcoming barriers to self-management: The person-centred diabetes foot behavioural agreement. The Foot, 38, pp.65-69.
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Jones, P.J., Bibb, R.J., Davies, M.J., Khunti, K., McCarthy, M., Fong, D.T. and Webb, D., 2019. A fitting problem: Standardising shoe fit standards to reduce related diabetic foot ulcers. Diabetes research and clinical practice.
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Insoles

Systematic Reviews

Nilsen, F., Molund, M., Lium, E.M. and Hvaal, K.H., 2022. Material Selection for Diabetic Custom Insoles: A Systematic Review of Insole Materials and Their Properties. JPO: Journal of Prosthetics and Orthotics.
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Observational Studies

Chatzistergos, P.E., Gatt, A., Formosa, C., Sinclair, J.K. and Chockalingam, N., 2023. Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear. Diabetes Research and Clinical Practice, 204, p.110914.
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Thimabut, W., Thimabut, N., Peng, L. and Hou, Z.G., 2024. Novel Vibrating Foot Orthoses for Improving Tactile Sensation in Type 2 Diabetes With Peripheral Neuropathy. IEEE Transactions on Neural Systems and Rehabilitation Engineering.
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Editorial Information

Last reviewed: 01/12/2024

Next review date: 01/12/2025

Approved By: British Association of Prosthetists and Orthotists (BAPO)

Reviewer name(s): Laura Barr, British Association of Prosthetists and Orthotists (BAPO) Professional Affairs Committee .