The effects of heel-elevated total contact insole on rearfoot pressure reduction in heel injury patients who had neurosensory impairment after receiving reconstructive flap operations

Objective: To evaluate the effects of a custom-molded heel-elevated total contact insole (TCI) on rearfoot pressure reduction and heel cushion for patients with heel-reconstruction. Methods: Eleven patients with unilateral heel-reconstruction were recruited in this study. Maximal force and plantar pressures (peak pressure and pressure-time integral) at three different areas (heel, midfoot, and forefoot) were measured under 3 randomized conditions (shoe-only, flat insole, and heel elevated TCI) after wearing a heel-elevated TCI for 3 months. Ulceration inspection and pain intensity were evaluated before and 3 months after wearing a heel-elevated TCI. Results: Pain intensity was decreased and walking velocity was improved in all patients (p<0.01), and ulcerations were completely healed in all of the five patients who had heel ulcers 3 months after wearing heel-elevated TCIs. Compared to shoe-only condition, the heel-elevated TCI was effectively reduced maximal force and plantar pressures in heel area (p<0.01) while part of the body weight was shifted from heel to midfoot and forefoot. Plantar pressures in heel area were more effectively reduced in the heel-elevated TCI than in the flat insole (p<0.05). Conclusion: These findings suggested that heel-elevated TCI provided more effective heel pressure reduction and shock absorption, and resulted in improvement of clinical symptoms. (C) 2015 Elsevier B.V. All rights reserved.