medwireNews: Providing additional shoes designed for wearing indoors may improve use of custom-made footwear among people with diabetes at high risk for foot ulceration, research suggests.
“Custom-made footwear is an effective intervention to help prevent foot ulceration and is recommended in international guidelines,” but ensuring consistent use is “a challenge,” particularly indoors, explain Sicco Bus and co-authors from Amsterdam University Medical Center in the Netherlands.
To address this issue, the researchers carried out a study of 31 people with type 1 (23%) or type 2 (77%) diabetes with moderate-to-high risk for plantar foot ulceration who already possessed custom-made footwear prescribed by a rehabilitation medicine specialist. These people were provided with additional custom-made footwear specifically designed for indoor use, with the same biomechanical offloading capacity as their existing footwear.
Overall use – defined as the proportion of steps taken in prescribed footwear based on footwear use and step count measurements over 7 consecutive days – improved significantly from 71% at baseline to 83% at 1 month and 90% at 1 year. This was driven by a significant increase in indoor use, from 57% to 77% and 84%, respectively, while outdoor use at the three timepoints remained high throughout the study, at 96–100%.
Similarly, when the analysis was restricted to the 23 participants categorized as having low indoor use (<80% of steps taken in prescribed footwear) at baseline, indoor use increased significantly from 48% at baseline to 71% and 77% at 1 month and 1 year, respectively.
A total of 44% of individuals with low use at baseline achieved high use (≥80%) at 1 month, as did 55% at 1 year. Median time spent wearing prescribed footwear (indoor or outdoor) similarly increased from 8.6 hours/day at baseline to a respective 9.3 and 12.0 hours/day at 1 month and 1 year.
Bus and colleagues note that both use and wearing time “remained high” throughout the study in the eight people with high use at baseline.
They report in BMJ Open Diabetes Research & Care that 79% of the 28 participants who responded to a usability questionnaire said that they were satisfied or very satisfied with the indoor custom-made footwear. However, all but one reported negative usability factors including “too heavy” and “skin irritation.”
These findings indicate that a “combination of regular and indoor custom-made footwear is a useful intervention to increase adherence, and its implementation is recommended,” write the researchers.
They conclude: “Although our results suggest that indoor footwear potentially may help in ulcer prevention, its effectiveness should be assessed in a randomized controlled trial […] with ulcer recurrence as a primary outcome.”
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BMJ Open Diabetes Res Care 2022; 10: e002593