To the Editor: Dr Reiber and colleagues1 found that therapeutic footwear did not prevent
foot ulceration in patients with diabetes. There are a number of limitations
of the study, however, that lead to a more cautious interpretation than that
which the authors have proposed.
First, almost half of the participants in the study had intact protective
sensation. These patients were, therefore, not at risk for foot injury according
to the currently accepted criteria of neuropathy and/or vascular disease.2 Apparently, many of the participants had only prior
minor traumatic abrasions, nonplantar lesions, or nail-bed infections rather
than the neuropathic plantar ulcers that are thought to benefit from footwear
intervention. This may also partly explain the low event rate.
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