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To the Editor: Dr Reiber and colleagues¹ found that therapeutic footwear did not prevent foot ulceration in patients with diabetes. There are a number of limitations of the study, however, that lead to a more cautious interpretation than that which the authors have proposed.

First, almost half of the participants in the study had intact protective sensation. These patients were, therefore, not at risk for foot injury according to the currently accepted criteria of neuropathy and/or vascular disease.² Apparently, many of the participants had only prior minor traumatic abrasions, nonplantar lesions, or nail-bed infections rather than the neuropathic plantar ulcers that are thought to benefit from footwear intervention. This may also partly explain the low event rate.

Second, the authors' definition of an ulcer (ie, persistence for 30 days) was overly conservative. A full-thickness foot lesion that is present for 29 days is potentially limb-threatening,³ yet it would not have . . . [Full Text of this Article]

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