The effectiveness of orthotic insole materials for diabetic foot offloading : a systematic review

Abstract

Review objectives: 'What is the effectiveness of different orthotic insole materials for diabetic foot offloading in reducing plantar pressure and improving biomechanical and clinical outcomes in adults living with diabetic peripheral neuropathy? 'To systematically evaluate the evidence on orthotic insole materials used for diabetic foot offloading, focusing on their biomechanical effectiveness, clinical outcomes, and relevance for the development of innovative insole materials.

The following questions will be investigated:

1. How effective are commonly used orthotic insole materials, including EVA, Plastazote, PORON, polyurethane, gel, memory foam and viscoelastic materials, in reducing plantar pressure in adults with diabetic peripheral neuropathy?

2. What effects do orthotic insole materials have on pressure–time integral, shear stress/forces, shock absorption and plantar pressure distribution in adults with diabetic peripheral neuropathy?

3. What clinical outcomes are associated with the use of orthotic insoles in diabetic foot management, including ulcer prevention, ulcer recurrence, comfort, adherence and patientreported outcomes?

4. What evidence exists regarding innovative orthotic insole materials, including non-Newtonian and adaptive polymers, and what knowledge gaps remain in their development and evaluation for diabetic foot offloading?