A Comparison of Insoles Used to Prevent Neuropathic Diabetic Foot Ulceration

This study has been completed.
Sponsor:
Collaborators:
Cornwall and Illes of Scilly Primary Care Trust
Plymouth Teaching Primary Care Trust
Diabetes UK
Information provided by:
University of Plymouth
ClinicalTrials.gov Identifier:
NCT00999635
First received: October 21, 2009
Last updated: October 23, 2009
Last verified: October 2009
  Purpose

Importance of the topic:

Lower extremity amputation is a costly complication of diabetes for both the NHS and the patient. Amputation may be avoided if the preceding foot ulceration can be prevented. One method of reducing the risk of ulceration in the neuropathic foot is through the provision of therapeutic insoles. The type of insole prescribed (prefabricated verses custom made) is currently based on anecdotal evidence. The idea held by many practitioners that the custom made insole is superior in its effect remains speculation, unsupported by the evidence. In the absence of economic analysis, the available data suggests that the custom insole is substantially more expensive to the NHS. This study, to determine which of two types of insole used in therapeutic shoes reduces peak pressure more in the at−risk diabetic foot, is therefore a very important topic and will provide both useful evidence for the NHS podiatry services. It is of course also very important for patients with diabetes as the personal suffering of those undergoing amputation is immense.

The study is a single blind randomised controlled trial comparing custom made with 'off the shelf' insoles.


Condition Intervention Phase
Diabetes
Neuropathic Foot
Device: Insole
Phase 2
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Prevention
Official Title: A Comparison of Functional and Prefabricated Insoles Used for the Preventative Management of Neuropathic Diabetic Foot Ulceration: a Single Blind Randomised Control Trial

Resource links provided by NLM:


Further study details as provided by University of Plymouth:

Primary Outcome Measures:
  • Reduction in peak pressure [ Time Frame: 6-months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Comparison of cost [ Time Frame: 6-months ] [ Designated as safety issue: No ]

Enrollment: 119
Study Start Date: March 2006
Study Completion Date: September 2008
Primary Completion Date: September 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Custom made insole
Custom made functional moulded insole
Device: Insole
Comparison of custom made and prefabricated insoles designed for the neuropathic diabetic foot, issued for day time wear and followed for a 6 month period
Active Comparator: Prefabricated Insole
Prefabricated accommodative moulded insole
Device: Insole
Comparison of custom made and prefabricated insoles designed for the neuropathic diabetic foot, issued for day time wear and followed for a 6 month period

Detailed Description:

Aim The study compared custom-made functional insoles with prefabricated insoles for the preventative management of neuropathic diabetic feet, assessing effects on peak pressure, forefoot pressure time integral, total contact area, forefoot rate of loading, duration of load as a percentage of stance, quality of life, perceived foot health and cost.

Method Pilot work investigating the physical properties of materials used to fabricate insoles informed material selection. A single-blind randomised control trial recruited 119 neuropathic participants with diabetes from two Primary Care Trusts and randomly allocated them to either custom-made functional insoles or prefabricated insoles. Data was collected at issue and 6-month follow-up, using the F-scan in-shoe pressure measurement system. Patient perceptions were assessed with the Bristol Foot Score and Audit of Diabetes Dependant Quality of Life. Further analyses were carried out on two subgroups; 1) insole effect on peak pressure in 44 participants with pronated feet, over a 6-month follow-up period; 2) insole durability, investigated in a second subgroup of 60 participants for 12-months. Durability was evaluated in terms of change in insole thickness and reduction in peak pressure.

To increase the robustness of results, data analysis was calculated using three strategies; 1) pure intention-to-treat analysis, including all 119 participants randomised to an intervention; 2) intention-to-treat analysis, using all available data; 3) as-treated analysis, including those participants self-reporting full insole compliance, defined as 60% or more daytime wear.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • diagnosed as having Type 1 or 2 diabetes mellitus, (recorded within the case notes and confirmed by participant),
  • diagnosed with diabetic peripheral neuropathy
  • palpable or biphasic pulses
  • intact from lower limb vascular or neuropathic ulceration, scoring Grade 0 on the Wagner classification for foot ulcer
  • able to walk a minimum of 10 metres unaided
  • willing to comply with the requirements of the study.

Exclusion Criteria:

  • presented with current or recently healed ulceration less than 6 months prior to study enrolment,
  • severe fixed mid-foot or rearfoot deformity e.g. charcot joint, unsuitable for prefabricated insoles and non- bespoke footwear,
  • history of major bone or joint surgery of the lower limb including major amputation
  • unable to comprehend simple instructions and comply with the study protocols and procedures.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00999635

Locations
United Kingdom
Liskeard Community Hospital
Liskeard, Cornwall, United Kingdom
Local Care Center Mount Gould
Plymouth, Devon, United Kingdom
Sponsors and Collaborators
University of Plymouth
Cornwall and Illes of Scilly Primary Care Trust
Plymouth Teaching Primary Care Trust
Diabetes UK
Investigators
Study Director: Ray Jones, Professor University of Plymouth
Principal Investigator: Joanne Paton, PhD University of Plymouth
  More Information

No publications provided

Responsible Party: Dr Joanne Paton, University of Plymouth
ClinicalTrials.gov Identifier: NCT00999635     History of Changes
Other Study ID Numbers: 05/Q2103/150
Study First Received: October 21, 2009
Last Updated: October 23, 2009
Health Authority: United Kingdom: Research Ethics Committee

Keywords provided by University of Plymouth:
Insoles
Prevention of Ulceration
Diabetic Foot
Neuropathic

Additional relevant MeSH terms:
Ulcer
Foot Ulcer
Diabetic Foot
Pathologic Processes
Foot Diseases
Skin Diseases
Leg Ulcer
Skin Ulcer
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Diabetic Neuropathies

ClinicalTrials.gov processed this record on July 20, 2014