On the design and evaluation of adjustable footwear for the prevention of diabetic foot ulcers

Worldwide there are over 422 million people with diabetes. Up to 34% of them will develop a diabetic foot ulcer. These ulcers are extremely dangerous and can result in amputation of the affected leg. Elevated pressures at the plantar surface of the foot are a major cause of diabetic foot ulcerations.
Diabetic foot ulcers can be prevented by reducing plantar pressures that are too high. Special footwear such as custom-made insoles and rocker profile shoes are commonly used to reduce plantar pressure. However, the design of this footwear is mainly based on the experience of the prescribing specialist and orthopaedic shoe technician. This leads to a large variety of results and sometimes to insufficient offloading of the foot. Even when the insole or rocker profile shoe initially is effective, over time the location of the pressure spots can shift, resulting in poor offloading and putting the person at risk again of developing an ulcer.
The work in this thesis aimed to overcome the problems with the current offloading footwear and includes the design and evaluation of an adjustable rocker profile and a self-adjusting insole.