{"id":63720,"date":"2026-07-22T10:14:02","date_gmt":"2026-07-22T03:14:02","guid":{"rendered":"https:\/\/www2.si.mahidol.ac.th\/en\/?p=63720"},"modified":"2026-07-22T10:14:02","modified_gmt":"2026-07-22T03:14:02","slug":"comparative-analysis-of-three-types-of-therapeutic-offloading-diabetic-shoes-with-custom-made-insole-on-plantar-pressure-distribution-in-severe-diabetic-charcot-foot","status":"publish","type":"post","link":"https:\/\/www2.si.mahidol.ac.th\/en\/highlights\/comparative-analysis-of-three-types-of-therapeutic-offloading-diabetic-shoes-with-custom-made-insole-on-plantar-pressure-distribution-in-severe-diabetic-charcot-foot\/","title":{"rendered":"Comparative Analysis of Three Types of Therapeutic Offloading Diabetic Shoes with Custom-Made Insole on Plantar Pressure Distribution in Severe Diabetic Charcot Foot"},"content":{"rendered":"<div id='av_section_1'  class='avia-section av-av_section-be5469b648f3c66bc848ea728be917cc main_color avia-section-small 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itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><h2>Comparative Analysis of Three Types of Therapeutic Offloading Diabetic Shoes with Custom-Made Insole on Plantar Pressure Distribution in Severe Diabetic Charcot Foot<\/h2>\n<\/div><\/section><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-11  el_after_av_three_fifth  el_before_av_one_fifth  flex_column_div  '     ><\/div><div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-12  el_after_av_one_fifth  el_before_av_three_fifth  first flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-13  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><section  class='av_textblock_section av-mrvi2ite-0723d32e8502a4f5024afac55b81135a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><h6><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-63721\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/017-Dr.Muhammad-Nouman-207x300.png\" alt=\"\" width=\"207\" height=\"300\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/017-Dr.Muhammad-Nouman-207x300.png 207w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/017-Dr.Muhammad-Nouman-711x1030.png 711w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/017-Dr.Muhammad-Nouman-486x705.png 486w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/017-Dr.Muhammad-Nouman.png 745w\" sizes=\"auto, (max-width: 207px) 100vw, 207px\" \/><\/h6>\n<h6>Author: Lecturer Muhammad Nouman, PhD<br \/>\nSirindhorn School of Prosthetics and Orthotics<\/h6>\n<\/div><\/section><br \/>\n<section  class='av_textblock_section av-mrvi2o96-1916a8b928c53d8a14be97de0b5c559d '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-63723\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Charcot-foot-ulcer.png\" alt=\"\" width=\"840\" height=\"1080\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Charcot-foot-ulcer.png 840w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Charcot-foot-ulcer-233x300.png 233w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Charcot-foot-ulcer-801x1030.png 801w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Charcot-foot-ulcer-768x987.png 768w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Charcot-foot-ulcer-548x705.png 548w\" sizes=\"auto, (max-width: 840px) 100vw, 840px\" \/><\/p>\n<p><strong>Pathophysiology of Charcot Foot Deformity<\/strong><br \/>\n<em>Charcot foot (Charcot neuroarthropathy)<\/em> is a severe complication documented in patients with diabetes mellitus, characterized by the progressive destruction of pedal bones and joints. This leads to structural degeneration, midfoot collapse, and ultimate foot deformity. Furthermore, it induces peripheral nerve damage, resulting in a loss of protective sensation (LOPS). Consequently, patients continue to bear weight without pain perception, even when plantar pressures elevate to dangerous clinical levels. When excessive pressure is repetitively concentrated on a specific anatomical area over prolonged periods\u2014particularly at the collapsed midfoot\u2014it precipitates the development of plantar ulcers or recurrent ulcerations. If these ulcers become severe or infected, amputation may be required to prevent the proximal progression of infection and tissue necrosis.<\/p>\n<p><strong>Challenges in Charcot Foot Management<\/strong><br \/>\nThe prescription of therapeutic footwear and custom-made insoles plays a pivotal role in evenly distributing plantar pressure across the foot, thereby mitigating repetitive loading on high-risk areas to prevent ulceration. This biomechanical intervention enables patients to perform activities of daily living with enhanced safety. However, there is currently a lack of a definitive clinical consensus regarding which specific design of therapeutic shoes is most optimal for this patient cohort. Therefore, this study was conducted to compare the efficacy of three distinct types of therapeutic shoes in reducing and redistributing plantar pressure to safe thresholds, aiming to provide evidence-based data for optimal footwear selection in clinical care.<\/p>\n<p><strong>Evaluating the Efficacy of Footwear on Plantar Pressure Reduction<\/strong><br \/>\nThis experimental trial evaluated 15 participants diagnosed with chronic severe diabetic Charcot foot. All subjects were assessed while wearing three variations of therapeutic shoes: (1) <em>off-the-shelf therapeutic shoes<\/em>, (2) <em>double rocker sole shoes<\/em>, and (3) <em>relasting shoes<\/em>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-63722\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types.png\" alt=\"\" width=\"1920\" height=\"564\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types.png 1920w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types-300x88.png 300w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types-1030x303.png 1030w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types-768x226.png 768w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types-1536x451.png 1536w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types-1500x441.png 1500w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/07\/Therapeutic-shoe-types-705x207.png 705w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p>All footwear interventions were uniformly paired with identical custom-made insoles. Participants were instructed to perform a 10-meter walking trial, during which in-shoe plantar pressure distribution was quantified using the Pedar X<sup>\u00ae<\/sup> system. Measurements were acquired across three specific anatomical regions: the forefoot, midfoot, and hindfoot.<\/p>\n<p>The results demonstrated that all three shoe types successfully offloaded peak plantar pressures at the midfoot\u2014an anatomical region highly susceptible to ulceration in this demographic\u2014to below 200 kPa, which is fundamentally established as a safe ulceration threshold. Peak pressures exceeding this limit inherently carry a high risk of causing skin breakdown and subsequent ulcer formation. A comparative analysis revealed that the off-the-shelf therapeutic shoes and the double rocker sole shoes reduced midfoot pressure by 11.97% and 8.73%, respectively. Conversely, while the relasting shoes demonstrated slightly lower efficiency in midfoot pressure reduction relative to the first two designs, they still successfully maintained the overall plantar pressure within the clinically safe threshold.<\/p>\n<p><strong>Conclusion<\/strong><br \/>\nAll three therapeutic shoe designs demonstrated comparable efficacy in offloading and redistributing plantar pressure, yielding no statistically significant differences. Therefore, the optimal prescription of footwear must be clinically individualized, taking into account the specific anatomical characteristics of the patient\u2019s resultant foot deformity. This intervention must invariably be utilized in conjunction with custom-made insoles to effectively offload plantar pressure and successfully prevent the onset of ulcerations.<\/p>\n<\/div><\/section><\/p><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-16  el_after_av_three_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-17  el_after_av_one_fifth  el_before_av_one_fifth  first flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-18  el_after_av_one_fifth  avia-builder-el-last  flex_column_div  column-top-margin'     ><\/div><\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='av_section_4'  class='avia-section av-av_section-f22f0f9dd672aac3df52cf5913f6ac08 main_color 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class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-03-05T16:27:46+07:00\" >March 5, 2026<\/time><h3 class='av-magazine-title entry-title '  itemprop=\"headline\" ><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-abroad-at-the-36th-american-glaucoma-society-aunnual-meeting-in-usa\/' title='Link to: Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA'>Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA<\/a><\/h3><\/header><\/div><footer class=\"entry-footer\"><\/footer><\/article><article class='av-magazine-entry av-magazine-entry-id-62460 av-magazine-format-standard av-magazine-type-post av-magazine-entry-2 av-magazine-entry-small '  itemscope=\"itemscope\" 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