Footwear for Diabetic Foot Complications

Abstract

Therapeutic footwear for patients with diabetic foot complications is a crucial biomechanical intervention addressing neuropathy, ischemia, and deformities. Engineered to redistribute plantar pressure, absorb shock, and protect tissue, its effectiveness relies on harmonizing each component with foot anatomy to mitigate abnormal plantar pressure and ulcer risk. Key design features include roomy, extra-depth toe boxes to accommodate deformities, reinforced heel counters for rearfoot stability, multilayered insoles providing cushioning and total contact support to offload bony prominences, and outsoles, often with rocker profiles, to reduce forefoot dorsiflexion demands and prevent forefoot ulcers. Understanding biomechanical principles allows clinicians to select or modify footwear that functions as a therapeutic device, supporting gait, accommodating deformities, and reducing shear stress. Peak plantar pressure, often highest under the forefoot, can reach 120% of body weight during ambulation. Footwear recommendations vary by risk level, from off-the-shelf shoes for low risk to medical-grade custom shoes for severe deformities. Shoe modifications, such as different rocker sole designs (forefoot, double, negative heel) and excavation techniques, offer target offloading for specific patients with neuropathy. It involves ensuring adequate toe clearance, width, depth for insoles, and heel fit. Clinicians must educate patients on incremental wear and daily foot inspection. Optimal footwear balances support and space to offload pressure. Ultimately, properly fitting therapeutic footwear significantly reduces mechanical stress leading to ulcers, preserving mobility and preventing devastating outcomes.