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Therapeutic Footwear in Patients With Diabetes—Reply

Gayle E. Reiber, MPH, PhD; Douglas G. Smith, MD; Patrick J. Heagerty, PhD; Joseph LeMaster, MD; Carolyn Wallace, PhD; Shane G. Hayes, CPed; Katrina Sullivan, DPM; Mathew Maciejewski, PhD; Onchee Yu, MS
JAMA. 2002;288(10):1231-1233. doi:10.1001/jama.288.10.1229.
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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 significant difference.


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