2020/11/03 by R. Keukenkamp, T. E. Busch‐Westbroek, R. Barn +2 · 1 citation
paper · doi:10.1111/dme.14438
Abstract Aims To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. Methods Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom‐made footwear were assessed with regard to barefoot and in‐shoe plantar pressures during walking, footwear adherence (% of daily steps over 7‐day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non‐Charcot foot group) with custom‐made footwear and similar ulcer risk factors. Results Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non‐Charcot foot group [756 (260–1267) vs 146 (100–208) kPa; P P =0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non‐Charcot foot group ( P =0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non‐Charcot foot group (1/55; P= 0.001). Conclusions Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom‐made footwear design may be required to improve clinical outcome.