{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T05:00:39Z","timestamp":1776574839108,"version":"3.51.2"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,3,28]],"date-time":"2015-03-28T00:00:00Z","timestamp":1427500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003092","name":"Diabetes Fonds","doi-asserted-by":"publisher","award":["2007.00.067"],"award-info":[{"award-number":["2007.00.067"]}],"id":[{"id":"10.13039\/501100003092","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"publisher","award":["14350054"],"award-info":[{"award-number":["14350054"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Dutch Foundation for the Development of Orthopaedic Footwear","award":["DIAFOS"],"award-info":[{"award-number":["DIAFOS"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Custom\u2010made footwear is used to offload the diabetic foot to prevent plantar foot ulcers. This prospective study evaluates the offloading effects of modifying custom\u2010made footwear and aims to provide data\u2010driven directions for the provision of effectively offloading footwear in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty\u2010five people with diabetic neuropathy and a recently healed plantar foot ulcer, who participated in a clinical trial on footwear effectiveness, had their custom\u2010made footwear evaluated with in\u2010shoe plantar pressure measurements at three\u2010monthly intervals. Footwear was modified when peak pressure was \u2265\u00a0200\u00a0<jats:styled-content style=\"fixed-case\">kP<\/jats:styled-content>a. The effect of single and combined footwear modifications on in\u2010shoe peak pressure at these high\u2010pressure target locations was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All footwear modifications significantly reduced peak pressure at the target locations compared with pre\u2010modification levels (range \u20136.7% to \u201324.0%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). The metatarsal heads were most frequently targeted. Repositioning an existing (trans\u2010)metatarsal pad in the shoe insole (\u201315.9% peak pressure relief), applying local cushioning to the insole (\u201315.0%) and replacing the insole top cover with Plastazote (\u201314.2%) were the most effective single modifications. Combining a new Plastazote top cover with a trans\u2010metatarsal bar (\u201324.0% peak pressure relief) or with local cushioning (\u201322.0%) were the most effective combined modifications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In people with diabetic neuropathy and a recently healed plantar foot ulcer, significant offloading can be achieved at high\u2010risk foot regions by modifying custom\u2010made footwear. These results provide data\u2010driven directions for the design and evaluation of custom\u2010made footwear for high\u2010risk people with diabetes, and essentially mean that each shoe prescribed should incorporate those design features that effectively offload the foot.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.12741","type":"journal-article","created":{"date-parts":[[2015,3,12]],"date-time":"2015-03-12T12:09:04Z","timestamp":1426162144000},"page":"790-797","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Data\u2010driven directions for effective footwear provision for the high\u2010risk diabetic foot"],"prefix":"10.1111","volume":"32","author":[{"given":"M. L. 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