Are arch-conforming insoles a good fit for diabetic foot? Insole customized design by using finite element analysis

Plantar ulceration is one of the leading complications for diabetic patients. To reduce the risk of plantar ulceration, people with diabetic neuropathy often used custom insoles to offload high pressures from the metatarsal. However, the current custom arch-conforming insoles, totally contact with the foot, could affect the flow of blood and produce adverse effects on foot ulcers. This study is aimed to propose novel custom insoles for diabetic foot and to make a comparison between the traditional insoles and the proposed one. The novel pressure-relieving insole is a layered modular insole that includes eight layers of small cushions. The results showed that the current custom insoles would increase the insole volume and squeeze the space available for the foot, and then the constrictive box of the footwear could deteriorate the blood flow of the foot and produce adverse effects on foot ulcers. The novel insoles were found to reduce the peak pressure from 208.86 to 160.02 kPa. High pressure was not observed in the sensitive locations of diabetic foot in this study, and the novel insoles fit diabetic foot better.