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01-12-2013 | Research | Uitgave 1/2013 Open Access

Journal of Foot and Ankle Research 1/2013

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

Journal of Foot and Ankle Research > Uitgave 1/2013
Tung-Liang Lin, Huey-Min Sheen, Chin-Teng Chung, Sai-Wei Yang, Shih-Yi Lin, Hong-Ji Luo, Chung-Yu Chen, I-Cheng Chan, Hsu-Sheng Shih, Wayne Huey-Herng Sheu
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-6-29) contains supplementary material, which is available to authorized users.
Tung-Liang Lin, Huey-Min Sheen contributed equally to this work.

Competing interests

The authors have no potential conflicts of interest relevant to this article to report.

Authors’ contributions

TLL and HMS researched data, reviewed and wrote the manuscript. CTC and SYL contributed to project planning and objectives recruitment. SWY and HJL contributed to outcome interpretation, discussion, and revision. ICC assisted in data analysis and regulation of the experimental procedures. CYC and HSS assisted in the instrument operation and data analysis instruction. WH-HS contributed to the direction of the study, objectives recruitment, reviewed and revised the manuscript. All the authors read and approved the final manuscript.



Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.


In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support).


Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions.


These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.

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Authors’ original file for figure 1
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