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Poorly fitting footwear has frequently been cited as an etiologic factor in the pathway to diabetic foot ulceration. However, we are unaware of any reports in the medical literature specifically measuring shoe size versus foot size in this high-risk population. We assessed the prevalence of poorly fitting footwear in individuals with and without diabetic foot ulceration. We evaluated the shoe size of 440 consecutive patients (94.1% male; mean ± SD age, 67.2 ± 12.5 years) presenting to an interdisciplinary teaching clinic. Of this population, 58.4% were diagnosed as having diabetes, and 6.8% had active diabetic foot ulceration. Only 25.5% of the patients were wearing appropriately sized shoes. Individuals with diabetic foot ulceration were 5.1 times more likely to have poorly fitting shoes than those without a wound (93.3% versus 73.2%; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–21.9; P = .02). This association was also evident when assessing only the 32.3% of the total population with diabetes and loss of protective sensation (93.3% versus 75.0%; OR, 4.8; 95% CI, 1.1–20.9; P = .04). Poorly fitting shoes seem to be more prevalent in people with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. This implies that appropriate meticulous screening for shoe-foot mismatches may be useful in reducing the risk of lower-extremity ulceration.
It may be of interest to those who are not too technophobic that Clarks shoe shops in the UK have just launched a new non-contact digital image capture system for measuring kids feet.
It measures the feet (Both together) then compares the measures against their shoe last dimension. It then suggets the best fit for the child via a nice touch screen.
Stating the obvious here but I am sure we can all imagine how useful this would be for the at risk foot. The only thing holding it back in healthcare is money - surprise surprise!!
Background: Fifteen per cent of patients with diabetes will develop a foot ulcer at some point in their life. Ill-fitting footwear frequently contributes to foot ulceration. A good fitting shoe is an essential component in the management of the diabetic foot. The objective of this study was to assess the feet and footwear of patients with diabetes to determine whether they are wearing the correct-sized shoes.
Methods: One-hundred patients with diabetes who were attending the general diabetic clinic had their foot length measured using a 'Clarks' shoe shop device and foot width using a pair of callipers. Measurements were taken whilst seated and standing. Shoe dimensions were also assessed by recording the manufactured shoe length and using callipers to assess shoe width. A calibrated measuring stick standardised shoe lengths. Neurovascular status and the presence of deformities in the foot were also recorded.
Results: One-third of diabetic patients were wearing the correct shoes on either foot whilst seated or whilst standing. However, only 24% of patients were wearing shoes that were of the correct length and width for both feet whilst seated and 20% upon standing. Seventeen per cent of patients appeared in both groups. No significance was found between any other variables, such as sensory neuropathy.
Conclusions: Many patients with diabetes wear shoes that do not fit, particularly, shoes that are too narrow for their foot width. Assessing the appropriateness of footwear maybe an important part of foot examination.
As today is World Diabetes Day, a couple of news stories on this have come out:
Innovations Report are reporting: 63% of diabetics risk serious foot problems by wearing the wrong-sized shoes
Quote:
More than six out of ten people with diabetes are walking around in the wrong-sized shoes, exposing themselves to serious foot problems that could lead to amputation, according to research in the November issue of IJCP, the International Journal of Clinical Practice.
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Published to coincide with World Diabetes Day (14 November) the study, by the University of Dundee, has been welcomed by an expert in podiatry. She says that ulceration can have serious implications for patients and health services, including impaired quality of life, increased amputation risk and even elevated death rates.
The United Nations, which passed a landmark resolution in December 2006 recognising diabetes as a chronic, debilitating and costly disease, has designated World Diabetes Day as an official United Nations Day for the first time in 2007.
And the World Health Organization has said that the number of people suffering from diabetes could double to 366 million by 2030 and that 80 per cent of diabetic foot amputations could be prevented.
A hundred patients aged 24 to 89 volunteered to take part in the shoe-size study carried out at a general diabetic clinic at Ninewells Hospital Medical School in Dundee, Scotland.
Patients who were also attending specialist foot clinics were excluded, as were patients who had problems standing or were wearing specially provided footwear.
“All the patients had their feet fully examined and measured while they were both sitting and standing” explains co-author Dr Graham Leese, a consultant at the clinic, which forms part of University of Dundee.
The team found that 63 per cent of the patients were wearing the wrong-sized shoes. For example, 45 per cent were wearing the wrong width fitting, with the majority being too narrow.
“When people stand up their feet change shape as the arch of the foot flattens and the foot becomes wider and longer” explains Dr Leese. “Taking both these sets of
measurements into account, only 37 per cent of the patients were actually wearing the right-sized shoes.
“Interestingly, patients who didn’t have problems with lack of feeling in their feet - a common problem with diabetes - were just as likely to wear badly fitting shoes as those who did.
“We also discovered that almost a third of the patients said they took a different shoe size to the one they were actually wearing. This isn’t helped by the fact that shoe sizes vary from make to make.”
45 per cent of the volunteers had experienced previous problems with their feet, including ulcers, callouses, bunions, corns or swelling. Despite this, 22 per cent never checked their own feet and only 29 per cent checked them daily.
Foot problems could be reduced by adults being offered foot-measuring services in shoe shops, say the researchers. They would also like to see manufacturers developing standardised shoe sizes and expanding the range of length and width fittings that they offer, especially for patients who have no feeling in their feet.
Podiatry expert Andrea Parnes, from the University of Ulster, agrees. She points out that, given the scale of the problem, it would make commercial sense for manufacturers to work with health professionals to expand their existing ranges.
In her accompanying editorial she calls for greater research into the problem, pointing out that the study also raises concerns about patients with conditions like rheumatoid arthritis.
The current issue of IJCP also includes a special supplement, which expresses support for the United Nation’s resolution on diabetes and highlights practical examples that have been shown to improve diabetes care.
These range from raising government awareness worldwide to empowering patients at grassroots level.
The Daily Mail have also picked up the story: Diabetics 'risk amputations by wearing ill-fitting shoes'
Quote:
A majority of diabetics are walking around in ill-fitting shoes, exposing themselves to serious foot problems that could lead to amputation, according to new research.
More than six out of ten people with diabetes were wearing wrong sized shoes, increasing their risk of ulceration, amputation and even death, the researchers from the University of Dundee said. ....
The study is far too small and further complicated by no universal criteria for what constitutes an 'approriate fit.' For centures shoe industries have blatently refused to set 'universal shoe sizing and no call for improved foot health will make a jot difference, I fear. I think these reports are 'well meant' and cover 'well ken't' ground but little else. I must say my attention was drawn more to the reported low up take of self examination, which I think speak's volumes.
Comparison of shoe-length fit between people with and without diabetic peripheral neuropathy: a case-control study
Alistair D McInnes, Farina Hashmi, Lisa J Farndon, Amanda Church, Maria Haley, Debora M Sanger and Wesley Vernon Journal of Foot and Ankle Research 2012, 5:9
Quote:
Background
Amongst 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.
Methods
A 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(R) and a Brannock Device(R), respectively.
Results
Data 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.
Conclusions
This 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.
Poor fitting shoes in those with diabetes
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