We aimed to comprehensively and systematically review studies associating key foot-loading factors (i.e., plantar pressure, weight-bearing activity, adherence or a combination thereof) with ulcer development and ulcer healing in people with diabetes. A systematic literature search was performed in PubMed and EMBASE. We included studies if barefoot or in-shoe plantar pressure, weight-bearing activity or footwear or device adherence was measured and associated with either ulcer development or ulcer healing in people with diabetes. Out of 1954 records, 36 studies were included and qualitatively analyzed. We found low to moderate quality evidence that lower barefoot plantar pressure and higher footwear and device adherence associate with lower risk of ulcer development and shorter healing times. For the other foot-loading factors, we found low quality evidence with limited or contradictory results. For combined measures of foot-loading factors, we found low quality evidence suggesting that lower cumulative plantar tissue stress is associated with lower risk of ulcer development and higher ulcer healing incidence. We conclude that evidence for barefoot plantar pressure and adherence in association with ulcer outcome is present, but is limited for the other foot-loading factors. More comprehensive investigation in particularly the combination of foot-loading factors may improve the evidence and targeting preventative treatment.

Adherence to prescribed footwear is essential to prevent diabetes-related foot ulcers. The aim was to compare different measures of adherence and wearing time of prescribed footwear with a reference adherence measure, among people with diabetes at high risk of foot ulceration. We followed 53 participants for 7 consecutive days. A temperature sensor measured wearing time of prescribed footwear and a triaxial accelerometer assessed weight-bearing activities. Subjective wearing time was self-reported. Reference adherence measure was proportion of weight-bearing time prescribed footwear was worn. We calculated Spearman’s correlation coefficients, kappa coefficients, and areas under the curve (AUC) for the association between the reference measure and other measures of adherence and wearing time. Proportion of daily steps with prescribed footwear worn had a very strong association (r = 0.96, Κ = 0.93; AUC: 0.96–1.00), objective wearing time had a strong association (r = 0.91, Κ = 0.85, AUC: 0.89–0.99), and subjective wearing time had a weak association (r = 0.42, Κ = 0.38, AUC: 0.67–0.81) with the reference measure. Objectively measured proportion of daily steps with prescribed footwear is a valid measure of footwear adherence. Objective wearing time is reasonably valid, and may be used in clinical practice and for long-term measurements. Subjective wearing time is not recommended to be used.

In evaluating therapeutic footwear, in-shoe plantar pressure is usually obtained during mid-gait steps at self-selected walking speed in a laboratory setting. However, this may not accurately represent plantar pressures or indicate the cumulative stress experienced in daily life. We investigated the effects of walking speed and different weight-bearing activities on in-shoe plantar pressure in people with diabetes at high risk of ulceration. In a cross-sectional study including 30 participants we compared in-shoe plantar pressures between three standardized walking speeds (0.8, 0.6 and 0.4 m/s) and between walking at self-selected speed and eight other weight-bearing activities (3 components of the Timed Up and Go test, accelerating, decelerating, stair ascending and descending, and standing). Mean forefoot regional peak plantar pressure and pressure-time integral were statistically assessed per foot using linear mixed models (α < 0.05) with Holm-Bonferroni correction. With increasing walking speed, peak pressures increased and pressure-time integrals decreased (P ≤ 0.014). Peak pressures during standing, decelerating, stair ascending and Timed Up and Go test were lower (P ≤ 0.001), and with other activities not different to walking at self-selected speed. Pressure-time integrals during stair ascending and descending were higher (P ≤ 0.001), during standing lower (P ≤ 0.009), and with other activities not different to walking at self-selected speed. In-shoe plantar pressure depends on walking speed and type of weight-bearing activity. Only measuring pressures to evaluate footwear at self-selected walking speed in a laboratory setting may not accurately represent the stress on the foot in daily life of the high-risk patient; a more comprehensive assessment is suggested.

Background Peripheral neuropathy is a common complication of diabetes and increases the risk of falls, possibly through gait (quality) impairments in daily life. Characteristics of gait quality have been associated with peripheral neuropathy in a laboratory setting, but little is known about the more relevant association with gait quality in daily life. Research question What is the association between peripheral neuropathy and gait quality characteristics in daily life in people with diabetes? Methods Data from two cross-sectional studies were combined in an exploratory analysis, including a total of 98 participants with diabetes (mean age: 68 (SD 7) years, 32 females), of which 68 with peripheral neuropathy. Participants wore a tri-axial accelerometer for seven consecutive days. Walking episodes >= 5 seconds were identified and analysed to determine various gait quality characteristics. Associations were assessed using linear regression analyses, adjusted for walking speed and other potential confounders. Results Peripheral neuropathy was significantly associated with a lower walking speed (people with neuropathy: 0.81 vs without neuropathy: 0.88 m/s; beta (95 % confidence interval (CI)): -0.114 (-0.202 to -0.026)), a lower stride frequency (0.81 vs 0.85 strides/s; beta (95 % CI): -0.030 (-0.057 to -0.003)), lower gait intensity (i.e. lower root mean square) in vertical direction (1.38 vs 1.63 m/s(2); beta (95 % CI): -0.074 (-0.143 to -0.006)), and less gait symmetry (i.e. lower harmonic ratio) in vertical direction (1.82 vs 2.27; beta (95 % CI): -0.322 (-0.474 to -0.170)). People with peripheral neuropathy had non-significantly poorer gait quality for most of the other 21 gait quality characteristics. Significance Peripheral neuropathy seems to negatively affect several gait quality characteristics measured in daily life. These results need to be replicated in future studies and may help to develop targeted gait training to improve gait quality and potentially reduce fall risk in people with diabetes and peripheral neuropathy.

Introduction: Adherence to wearing prescribed footwear is paramount in reducing the risk of developing diabetes‐related foot ulcers, but adherence is often lower than optimal. This study aimed to investigate predictors of footwear adherence and variations in adherence and activity in people at risk of diabetes‐related foot ulceration.Methods: Sixty people at high foot ulcer risk were included. We measured the proportion of weight‐bearing acitivity time the prescribed footwear was worn for seven days. Multiple linear regression and analysis of variance were used.Results: Mean overall adherence was 63%. Adherence was lower at home than away from home (59% vs. 74%), while activity was higher at home (2.2 vs. 1.2 h/day). Adherence was similar across activities (61%–63%). No variable predicted the overall adherence. Higher Hba1c predicted lower adherence at home (β = −0.34, p = 0.045, R² = 11.6%). More daily steps predicted lower adherence away from home (β = −0.30, p = 0.033, R² = 9.3%). Adherence and activity were highest in mornings (71%, 1.1 h) and afternoons (71%, 1.5 h), and lower in evenings (40%, 0.8 h) and at nights (9%, 0.1 h). Adherence was similar on weekdays and weekend days (63% vs. 60%), but activity was higher on weekdays (3.4 vs. 3.0 h).Conclusion: Adherence levels and predictors thereof differed between adherence at home and away from home, so we suggest to treat them as different concepts. Due to the low explained variance, future studies should focus on other predictors such as psychological variables.

This year in review (1) narratively synthesises the effect of, or patient experience with, non-pharmacological or non-surgical rehabilitation treatments for osteoarthritis at any joint; and (2) describes how sex and/or gender are defined, reported, and analysed. We searched three databases (Medline, Embase, CINAHL) for studies that met predefined criteria and selected those of perceived moderate-to-high quality and importance published between 12^th March 2024 and 1^st March 2025. Studies were grouped according to predominant treatment topic areas (e.g. core [exercise, diet]; adjunct [electrotherapy, manual therapy]; multimodal [different rehabilitation treatments]). Two authors independently screened records. One author extracted data, and another checked 10% of the accuracy. Full-text screening identified 158 eligible studies, reduced to 39 for synthesis. We identified eight themes: i) Exercise is effective for knee osteoarthritis and comorbidities, but has varied effects for hip osteoarthritis; ii) Diet plus exercise is effective for weight loss, but may not reduce pain; iii) Digital rehabilitation is a viable alternative to in-person care; iv) No added benefit of mind/behavioural treatments; v) Effects of electrotherapy modalities on pain were inconsistent and region-specific; vi) Orthoses may relieve pain, but should be individualised to patient preferences; vii) Acupuncture and blood flow restriction treatment show effectiveness in single clinical trials; viii) Treatment packages for osteoarthritis have varied benefits. Sex and gender were reported in 23 and 11 studies, respectively. For gender, most studies used female/male/woman/man interchangeably. No study defined sex or gender, 5% reported results disaggregated by sex or gender, no study justified why results were not, and 5% summarised key sex or gender findings.