{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T18:39:06Z","timestamp":1791052746743,"version":"4.1.0"},"reference-count":27,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bauerfeind\u00ae Orthopadie GmbH"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Pressure-relieving footwear helps prevent foot ulcers in people with diabetes. The footwear design contributes to this effect and includes the insole top cover. We aimed to assess the offloading effect of materials commonly used as insole top cover. We measured 20 participants with diabetes and peripheral neuropathy for in-shoe peak pressures while walking in their prescribed footwear with the insole covered with eight different materials, tested in randomized order. Top covers were a 3 mm or 6 mm thick open or closed-cell foam or a 6 mm thick combination of open- and closed-cell foams. We re-assessed pressures after one month of using the top cover. Peak pressures were assessed per anatomical foot region and a region of interest (i.e., previous ulceration or high barefoot pressure). Walking comfort was assessed using a 10-point Likert scale. Mean peak pressure at the region of interest varied between 167 (SD:56) and 186 (SD:65) kPa across top covers (p &lt; 0.001) and was significantly higher for the 3 mm thick PPT than for four of the seven 6 mm thick top covers. Across 6 mm thick top covers, only two showed a significant peak pressure difference between them. Over time, peak pressures changed non-significantly from \u22122.7 to +47.8 kPa across top cover conditions. Comfort ratings were 8.0 to 8.4 across top covers (p = 0.863). The 6 mm thick foams provided more pressure relief than the 3 mm thick foam during walking in high-risk people with diabetes. Between the 6 mm thick foams and over time, only small differences exist. The choice of which 6 mm thick insole top cover to use may be determined more by availability, durability, ease of use, costs, or hygienic properties than by superiority in pressure-relief capacity.<\/jats:p>","DOI":"10.3390\/s24175549","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T11:58:46Z","timestamp":1724759926000},"page":"5549","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco A.","family":"Bus","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Program Rehabilitation & Development, Amsterdam Movement Sciences Research Institute, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2949-8597","authenticated-orcid":false,"given":"Tessa E.","family":"Busch-Westbroek","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Program Rehabilitation & Development, Amsterdam Movement Sciences Research Institute, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Pulles","sequence":"additional","affiliation":[{"name":"Livit OttoBock Care, Kabelweg 40, 1060 JA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"van Dun","sequence":"additional","affiliation":[{"name":"Voetencentrum Wender, Sabina Klinkhamerweg 10, 7555 SK Hengelo, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghizella","family":"Szabo","sequence":"additional","affiliation":[{"name":"Livit OttoBock Care, Kabelweg 40, 1060 JA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario H.","family":"Lacorte","sequence":"additional","affiliation":[{"name":"Department of Human Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dannick","family":"Luckson","sequence":"additional","affiliation":[{"name":"Department of Human Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Program Rehabilitation & Development, Amsterdam Movement Sciences Research Institute, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1001\/jama.2023.10578","article-title":"Diabetic foot ulcers: A review","volume":"330","author":"Armstrong","year":"2023","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4109","DOI":"10.2337\/dc13-0996","article-title":"Effect of custom-made footwear on foot ulcer recurrence in diabetes: A multicenter randomized controlled trial","volume":"36","author":"Bus","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e3651","DOI":"10.1002\/dmrr.3651","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update)","volume":"40","author":"Bus","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1111\/dme.12741","article-title":"Data-driven directions for effective footwear provision for the high-risk diabetic foot","volume":"32","author":"Arts","year":"2015","journal-title":"Diabet. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.clinbiomech.2013.05.005","article-title":"Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes","volume":"28","author":"Chapman","year":"2013","journal-title":"Clin. Biomech."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.clinbiomech.2006.08.004","article-title":"The effects of insole configurations on forefoot plantar pressure and walking convenience in diabetic patients with neuropathic feet","volume":"22","author":"Guldemond","year":"2007","journal-title":"Clin. 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Diabetes Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"880","DOI":"10.3113\/FAI.2007.0880","article-title":"Physical properties, durability, and energy-dissipation function of dual-density orthotic materials used in insoles for diabetic patients","volume":"28","author":"Brodsky","year":"2007","journal-title":"Foot Ankle Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.3113\/FAI.2007.1057","article-title":"The physical characteristics of materials used in the manufacture of orthoses for patients with diabetes","volume":"28","author":"Paton","year":"2007","journal-title":"Foot Ankle Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e131","DOI":"10.1097\/JPO.0000000000000403","article-title":"Material Selection for Diabetic Custom Insoles: A Systematic Review of Insole Materials and Their Properties","volume":"34","author":"Nilsen","year":"2021","journal-title":"J. Prosthet. 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