The Effectiveness of Orthopaedic Insoles in Reducing Plantar Pressure and Preventing the Onset of First-Time or the Recurrence of Foot Ulcers in Diabetic Patients—A Systematic Review

Background/Objectives: Prevention of the first diabetic foot ulcer and subsequent ulcer recurrence is a key priority in diabetes care. Foot orthoses are used to redistribute plantar pressure and protect high-risk areas; however, their effectiveness in preventing ulceration remains uncertain. This systematic review aimed to evaluate the effectiveness of foot orthoses in modifying plantar pressure and preventing first or recurrent diabetic foot ulcers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. PubMed, Web of Science, and Embase were searched. Studies were selected according to predefined eligibility criteria related to publication type, language, patient characteristics, and the use of foot orthoses. Methodological quality and risk of bias were assessed using Joanna Briggs Institute critical appraisal tools. Results: The search identified 963 records. After screening and full-text assessment, 12 articles met the inclusion criteria; one additional article was identified and included subsequently, resulting in 13 studies. Overall, foot orthoses reduced plantar pressure, particularly beneath the metatarsal heads. However, the available evidence directly assessing the prevention of first or recurrent diabetic foot ulceration was limited. Conclusions: Foot orthoses may contribute to diabetic foot ulcer prevention by reducing plantar pressure in high-risk areas. Nevertheless, further well-designed longitudinal studies are needed to determine whether these biomechanical improvements translate into a reduction in ulcer incidence and recurrence.