In Reply: It is a common misconception that
all patients with diabetes and foot ulcers lack sensation. In response to
Dr Cavanagh and colleagues, we found that 58% of participants lacked sensation
to the Semmes-Weinstein monofilament at baseline and 66% at the study conclusion.
A large diabetes cohort study reported a 68% prevalence of insensitivity in
patients with ulceration.1 None of the participants
in our study had a history of paronychia. Results of a secondary analysis
of individuals who lacked sensation identified the 2-year reulceration rates
were 15% in cork inserts/therapeutic shoes, 13% in prefabricated polyurethane
inserts/therapeutic shoes, and 20% in controls. The rate ratio for ulcer episodes
for patients with customized cork inserts vs controls was 0.74 (95% confidence
interval [CI], 0.36-1.50), and the rate ratio for those with prefabricated
inserts vs controls was 0.66 (95% CI, 0.32-1.36); there was still no statistically
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