Prevention of Diabetic Foot Ulcers: From Biomechanics to Therapeutic Patient Education

Diabetic foot disease is one of the most invalidating long-term complications of diabetes. Given the dramatically increasing prevalence of types 1 and 2 diabetes mellitus worldwide, the medical community must be prepared for the number of diabetic foot ulcers and lower extremity amputations that will follow this “epidemic” of diabetes. In addition to economic costs, the psychological and biosocial aspects of people suffering from diabetes and diabetic foot disease must be considered. Studies have indicated that the implementation of validated guidelines and international standards of diabetic foot care into clinical practice could reduce lower extremity amputation rates by up to 85%. However, in many countries, such a decrease in lower extremity amputation rates is more of an isolated example than a rule. Reduction of the plantar pressure is mandatory for the treatment and prevention of foot ulcers in patients with diabetes and peripheral neuropathy. The recurrence rate of ulcers is extremely high. After ulcer healing, the persisting high plantar pressure during walking causes repeated soft tissue breakdown at each step. In this population, the development of a new walking strategy could alter the plantar pressure distribution under the feet, thus improving patient outcomes and preventing amputation. We have developed and implemented a biofeedback-based technique delivered by an electronic insole. When combined with therapeutic patient education, this method may be a valuable tool for the treatment of foot ulcers and prevention of lower extremity amputations in high-risk patients with diabetes