AdvAnces in diAbetic Foot MAnAgeMent: the clinicAl eFFectiveness oF Foot orthoses prescribed to control And reduce diAbetic Foot pAthology

223 IntroductIon In England, more hospital beds are filled with people who have diabetic foot complications, than are filled with all other diabetic complications combined.1 Diabetes may alter both the musculoskeletal and soft tissue mechanics in a manner that elevates plantar pressure and makes tissue damage more likely,2 causing non-resolving neuroischaemic ulcers at weight bearing sites.3 Most of the skin injuries seen on the feet of patients with diabetic neuropathy occur on the plantar surface, frequently at the sites of highest pressures under the foot. On average, patients with diabetes have higher pressures under their feet than persons without diabetes.4 Increased plantar pressure has been associated with recent or current ulcers, and with risk of amputation.5-7 In British studies, diabetic foot ulcer prevalence has ranged from 5.3% to 7.4%,8,9 and among persons with diabetes, approximately 15% will develop a foot ulcer during their lifetime.10,11 Recurrence rates for diabetic foot ulcers are 35-40% over three years and 70% over five years.12