300 Section - The Effect of Total Contact Insoles on a Diabetic unilateral Below Knee Amputee: A single case study

The reported five-year contralateral re-amputation rate among diabetic patients after major amputation is 20.5%, a progression that is associated with substantial disability as well as psychological and socioeconomic burden on both the patients and healthcare system. Despite these adverse outcomes, there remains a lack of comprehensive guidelines aimed at preventing contralateral limb ulceration.

We aim to assess the effect of total contact insoles on peak plantar pressure of the contralateral limb during walking in a diabetic patient with unilateral below-knee amputation, using the F-Scan system.

Design: A 62-year-old man with type 2 diabetes mellitus and a right transtibial amputation was recruited for this study. The participant ambulated using his prosthetic limb on the right and an in-house 3D-printed insole fitted into his left diabetic footwear (Dr. Comfort Carter’s). Walking was performed at a self-selected speed for a total duration of 1500 seconds, during which plantar pressure data were collected using the F-Scan in-shoe pressure measurement system with calibrated sensors. Measurements were obtained under two conditions: with and without the total contact insole. Peak plantar pressure was the primary outcome measure for analysis.

Results: The results demonstrated a 47% reduction in peak plantar pressure on the contralateral limb with the use of total contact insoles, while a 10% increase in peak pressure was observed on the ipsilateral prosthetic limb.

Conclusion: The use of total contact insoles in reducing plantar foot pressure on the contralateral limb may represent a potential strategy in foot ulcer prevention amongst diabetic amputees. However, larger prospective cohort studies including the ipsilateral limb assessment are required to establish its clinical effectiveness and applicability.