Abstract
BackgroundAmongst the many identified mechanisms leading to diabetic foot ulceration, ill-fitting footwear is one. There is anecdotal evidence that people with diabetic peripheral neuropathy wear shoes that are too small in order to increase the sensation of fit. The aim of this study was to determine whether people with diabetic sensory neuropathy wear appropriate length footwear.MethodsA case–control design was used to compare internal shoe length and foot length differences between a group of people with diabetes and peripheral sensory neuropathy and a group of people without diabetes and no peripheral sensory neuropathy. Shoe and foot length measurements were taken using a calibrated Internal Shoe Size Gauge® and a Brannock Device®, respectively.ResultsData was collected from 85 participants with diabetes and 118 participants without diabetes. The mean difference between shoe and foot length was not significantly different between the two groups. However, a significant number of participants within both groups had a shoe to foot length difference that lay outside a previously suggested 10 to 15 mm range. From the diabetic and non-diabetic groups 82% (70/85) and 66% (78/118), respectively had a foot to shoe length difference outside this same range.ConclusionsThis study shows that although there is no significant difference in shoe-length fit between participants with and without neuropathy, a significant proportion of these populations wear shoes that are either too long or too short for their foot length according to the 10 to 15 mm value used for comparison. The study has highlighted the need for standardised approaches when considering the allowance required between foot and internal shoe length and for the measurement and comparison of foot and shoe dimensions.
Highlights
Amongst the many identified mechanisms leading to diabetic foot ulceration, ill-fitting footwear is one
Harrison et al [22] considered foot length amongst other factors, the measurements were all taken with participants in a standing position and major differences were found in relation to width measurements
Outcome measurements were collected for 118 control participants and 85 people with diabetes and peripheral neuropathy
Summary
Amongst the many identified mechanisms leading to diabetic foot ulceration, ill-fitting footwear is one. Jeffcoate and Harding [4] and Pecoraro et al [5] found that in more than 80% of cases, amputation was preceded by foot ulceration. The financial burden is considerable and Gordois et al [6] identified that foot ulcerations and amputations cost the UK National Health Service (NHS) £244 million in 2001. Boulton [7] has suggested that the lifetime risk of those with diabetes developing a foot ulcer is as high as. The mechanisms leading to foot ulceration are either extrinsic (e.g. undetected trauma) or intrinsic to the foot (e.g. neuropathy contributing to foot deformity resulting in high multidirectional pressures during gait) [9,10]. Moulik et al [11] reported the presence of neuropathy in 61% of patients presenting to a foot clinic for the first time with a foot ulcer
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