Keynote: State of the Art Footwear

Increased mechanical load on the foot during ambulation is an important risk factor for foot ulceration in people with diabetes who have loss of protective sensation. Therefore, reduction of these pressures is important both in the prevention and treatment of these chronic wounds.

For ulcer prevention, special footwear (therapeutic, custom-made) is commonly prescribed to people with diabetes, in particular to those who are at moderate risk because of deformity present or high risk who have healed from a plantar foot ulcer. Such footwear aims to redistribute pressures on the foot and reduced pressure at locations that are at risk for ulceration (pressure points).

International guidelines from the IWGDF report on the importance of appropriately fitting and pressure-relieving footwear and insoles to prevent occurrence and recurrence of foot ulcers. Innovations in footwear technology include the use of plantar pressure measurements to guide design and modifications to the footwear that optimize the pressure relieving properties of the shoe. The efficacy of this approach has been tested and shown in several trials.

Other innovative methods are also available and may help to improve footwear design, and include the development of scientific-based protocols to help in clinical decision-making for the right type of footwear and for the right design at different levels of foot complications. The aim of such initiatives is eventually to design the most optimal shoe for a given patient at the right time, through a personalized state-of-the-art approach. However, the footwear can only be effective when worn and different solutions to improving footwear use are currently available, including the use of special footwear for indoors.

All these topics on footwear are investigated at the Amsterdam UMC Center for Diabetes-related foot Complications (ACDC) and will be discussed during the lecture, and also where the gaps in our knowledge are and a research agenda will also be presented