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Patient and professional perspectives on prescribed therapeutic footwear for people with diabetes: A vignette study. Patient Educ Couns. 2006 Feb 7; [Epub ahead of print]
Johnson M, Newton P, Goyder E.
Quote:
OBJECTIVE: This article draws on a qualitative study to identify and discuss patient and health professional views of the use of therapeutic footwear for people with diabetes-related foot complications.
METHODS: Semi-structured interviews were conducted with 15 patients and 15 health professionals using a 'vignette' technique. The interviews were audio-taped, and framework analysis was used to identify main themes and categories.
RESULTS: The prescription of therapeutic footwear was an important issue for patients, and health professionals were aware of this. The main issues were the differing perspectives between patients and professionals in terms of the expectations and reality of preventive behaviour, and difficulties in fitting shoes when feet are constantly changing shape.
CONCLUSIONS: Patients often have difficulty changing their shoe-wearing behaviour in line with guidelines, particularly within the limits of available therapeutic shoes. The choice of available shoes may not meet the varied and specific needs of patients. Patient perspectives therefore need to be taken into account in shoe provision.
PRACTICE IMPLICATIONS: The concept of concordance would appear to be useful in allowing patient needs to be identified before designing and prescribing therapeutic shoes. More choice in styles, and involving patients in footwear design and selection, might encourage the use of appropriate footwear.
I have a patient who continually refuses to wear 'grandma shoes' which by their definition is anything closed in with a lace. It is important to consider the patients perspective but one would think it slightly more important to advise more 'appropriate' and 'fitted' footwear, especially in cases where the diabetic foot has significantly changed shape. The patient's perspective that pointed toed high heels 'look great' when the forefoot is twice the size it's meant to be and almost at right angles to the rest of the foot doesn't really seem a viable one to me.
Patients with diseases which impact on foot health, for example diabetes and rheumatoid arthritis, are known to have some benefit from prescribed stock footwear with regards to clinical outcomes. Achieving this is not just about getting the footwear designed and fitted to meet the clinical needs, but it also requires that the patient wears the shoes. This means meeting the non-clinical needs or criteria of patients. The aim of this study was to compare perceptions of the same footwear between patients with diabetes and patients with rheumatoid arthritis (RA) with regard to specific design features. Fifty-four patients with RA and 40 patients with diabetes who required prescription footwear were asked to identify issues of importance, and to assess the features of five different pairs of stock footwear using a Likert scale scoring form. There was a difference between the RA and the diabetes groups with regards their overall requirements from the footwear with comfort being a priority in RA and style a priority for diabetes. Both groups rated the same footwear as overall best from the selection, but the scores suggest that there were features with the 'best' shoe which were not acceptable suggesting that even the 'best' shoe was a compromise This possibly indicates that existing footwear ranges do not meet all the patients' requirements. Patients have different perceptions with regard to what is important to them in terms of footwear with regards to the specific features of the footwear and one of the influences appears to be the underlying systemic disease. Patient-based criteria may be an important consideration in the design of the footwear.
I have found that most patients who qualify for the Diabetic shoe program here not only do not mind the shoes,they will insist on getting their pair.The shoes can help prevent ulcerations and the nice part,if you will is that they come at either no or little cost to the patient.Heck,even my office staff knows the drill..."Dr.Spina,this patient is a diabetic..please give her/him a pair of shoes.."
Patients have to be seen in a Diabetic Foot Clinic, the Pod then has to get a form signed by a Diabetologist. The patient then sees an Orthotist who either has a bespoke pair of shoes made (cost £150+ ) or a modified stock pair (cost £80+) or stock pair (cost£60+). These are provided free of charge to the patient, who may o may not wear them. An insole may or may not be provided (by orthotist or podiatrist) and the patient may of waited up to 3/4months for the shoes, so the foot may of changed shape again in the meantime and the shoes may not fit!!
The mentality in the UK is that if it is for free I'll take it but may or may not wear it!
patients tend to wear the footwear provided only when the feet have changed shape so much that they cannot fit them into 'standard' footwear.
The VAST majority of Diabetic aptients in the UK use standard footwar, we try to recommend Training shoes, as these are a good compromise (and yes we know they are a compromise, but its the best compromise available)
Robby:The same here.I DO have to have a doctor sign off on a form before it can be approved.They get 1 pair of shoes per year.The patients like this service and ask for it.I refer them to the pedorthist for the shoes,as stocking them and doing it myself appears to be,while profitable,a pain in the rump...besides,I go to a few offices and make house calls,so where in blazes will I keep the shoes?I do not make the big profit on it.All I get out of it is an increased supply of happy patients!
Attitudes to prescribed diabetic footwear
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