AN EXAMINATION OF THE EFFECT OF PRESCRIPTION FOOTWEAR ON THE KINEMATICS AND KINETICS OF GAIT: WITH A FOCUS ON DIABETES AND MATERIALS

For the prescription of insole/orthoses a vast range of materials are available to clinicians and with the limited scientific evidence available on their effectiveness material choice is often based on the clinician’s personal experience. Similarly therapeutic footwear play a major role in the prevention and treatment of diabetic ulcers and recommendations on suitable insole materials and construction are needed. The aim of the work undertaken in this thesis was to extend the current knowledge in the area of orthoses and prescription footwear in order to aid clinicians in patient treatment. Chapter 2 examined literature to date into materials used in footwear orthoses, concluding that at present recommendations for appropriate materials for different patient requirements are not possible. Chapter 3 examined the prescription procedures involved in the provision of foot orthoses by clinicians with an emphasis on material choice and highlighted the diversity in opinion among clinicians with regards to the available materials. Chapter 4 examined the characteristics of orthosis materials and how they affect gait providing information for a clinician to draw an evidence-based orthosis prescription centred on material properties. Two systematic reviews (Chapters 5 and 6) provide a concise review of research to date in the area of diabetic footwear, highlighting the dearth of information in the area, the limitations of the reviewed studies and providing recommendations for future research. The repeatability of a new pressure measurement system was examined in Chapter 7 with favourable results for the new system when compared to an established pressure measurement system. This research has contributed to clinical practice through the provision of valuable information on the performance of footwear materials and has led to the development of recommendations for future research in the area of prescription footwear