Comparative Effect of 3D Printed Customized Insoles and Ready to Wear Insoles on Plantar Pressure Changes in Patients With Diabetic Neuropathy

This is a single-blind, parallel-group randomized controlled trial conducted at DHQ-1 and DHQ-2 hospitals in Okara, Pakistan. Participants are adults aged 35-65 years with diagnosed diabetic neuropathy who can walk independently without aids. Exclusion criteria include foot ulcers, external wounds, recent surgery, major limb amputation, foot drop, peripheral vascular disease, neuromuscular diseases, and Charcot arthropathy. A consecutive sampling technique is used to recruit 22 participants. Randomization is performed using a computer-generated sequence. Participants are blinded to their group allocation. Group A receives 3D printed customized insoles tailored to individual foot morphology using 3D scanning and printing technology. These insoles provide arch support and gait alignment. Group B receives ready-to-wear insoles providing general cushioning and basic support. Both groups follow an 8-week intervention protocol: participants wear insoles for a minimum of 6 hours per day, 5 days per week, and perform level walking on a 28-meter pathway at self-selected speed. The protocol is divided into phases: weeks 1-2 for acclimatization and footwear assessment using Semmes-Weinstein 10g monofilament; weeks 3-4 for pressure adaptation and skin monitoring; weeks 5-6 for enhanced foot function and balance improvement; weeks 7-8 for final assessment. Primary outcome: plantar pressure measured via piezoresistive sensors and Arduino Nano Unit. Secondary outcomes: Foot Health Status Questionnaire (FSHQ), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0), Neuropathy Symptom Score (NSS), and Neuropathy Deficit Score (NDS). Data are collected at baseline, week 4, and week 8. Statistical analysis uses SPSS version 22.