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We searched multiple databases for published and unpublished studies reporting offloading footwear and insoles for people with diabetic neuropathy and nonulcerated feet. Primary outcome was foot ulcer incidence; other outcome measures considered were any standardized kinetic or kinematic measure indicating loading or offloading the plantar foot. Fifty\u2010four studies, including randomized controlled studies, cohort studies, case\u2010series, and a case\u2010controlled and cross\u2010sectional study were included. Three meta\u2010analyses were conducted and random\u2010effects modelling found peak plantar pressure reduction of arch profile (37\u00a0kPa (MD, \u221237.5; 95% CI, \u221272.29 to \u22123.61; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.03), metatarsal addition (35.96\u00a0kPa (MD, \u221235.96; 95% CI, \u221257.33 to \u221214.60; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and pressure informed design 75.4\u00a0kPa (MD, \u221275.4\u00a0kPa; 95% CI, \u2212127.4 to \u221223.44\u00a0kPa; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.004).The remaining data were presented in a narrative form due to heterogeneity. This review highlights the difficulty in differentiating the effect of different insole and footwear features in offloading the neuropathic diabetic foot. However, arch profiles, metatarsal additions and apertures are effective in reducing plantar pressure. The use of pressure analysis to enhance the effectiveness of the design of footwear and insoles, particularly through modification, is recommended.<\/jats:p>","DOI":"10.1002\/edm2.132","type":"journal-article","created":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T13:06:15Z","timestamp":1586610375000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":78,"title":["Footwear and insole design features for offloading the diabetic at risk foot\u2014A systematic review and meta\u2010analyses"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7048-1386","authenticated-orcid":false,"given":"Richard","family":"Collings","sequence":"first","affiliation":[{"name":"School of Health Professions Faculty of Health: Medicine, Dentistry and Human Sciences University of Plymouth Plymouth UK"},{"name":"Department of Podiatry, Torbay and South Devon NHS Foundation Trust Plymouth 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