• The increase in CoP gait-line lengthindicates greater overall CoP progression through stance. Together with the increase in stride length and walking velocity, this suggests that forefoot offloading was achieved without restricting forward progression during gait.

• Single-limb-support CoP line, lateral symmetry and maximum CoP gait-line velocity did not change significantly, indicating that the main effect was on overall progression rather than these secondary CoP measures.

• These findings reflect the combined condition of standard accommodative footwear with an appropriately designed diabetic insole. Further work will help determine the specific contribution of the insole and its longer-term clinical relevance.

 

Offloading should not be considered separately from walking function.

In this pilot cohort, standard accommodative footwear incorporating a novel diabetic insole was associated with approximately 45% lower forefoot pressure, while overall CoP progression, stride length and walking velocity increased.

Assessing pressure redistribution together with CoP progression and gaitmay provide a more complete biomechanical evaluation of diabetic insoles than pressure reduction alone.

 

These findings are part of an ongoing prospective study of people in remission following diabetic foot ulceration. The larger study will provide a more detailed characterisation of biomechanical function after ulcer healing and allow us to examine whether biomechanical characteristics and response to the insole are associated with time in remission and subsequent ulcer recurrence.

Further work will also:

• examine responses in a larger and more diverse cohort;

• investigate individual rather than only group-level biomechanical responses;

• include comprehensive movement analysis;

• separate the effects of the insole and footwear through a shoe-only comparator; and

• examine whether the biomechanical effects observed at baseline are maintained during longer-term use.