Diabetes Foot Ulcer Prevention: A Review of Footwear Width Assessment for At-Risk Feet.

BACKGROUND

Diabetes-related foot ulceration (DFU) is often related to footwear fit. People with diabetes often have wider feet than in those without diabetes. Standards for evaluating footwear width in those at risk are therefore important.

METHODS

We performed a systematic search with a narrative review to assess consensus in quantitative methods used to assess footwear width for people at risk of DFU within research studies, and how often footwear is considered too narrow or wide. Search terms included diabet*, footwear, fit, size and width. This returned 1397 results, with 16 studies included after full paper review.

RESULTS

Three standards emerged, defining incorrectly fitting footwear as (1) one shoe size or (2) one width fitting larger or smaller than feet (4-7 mm) or (3) measured shoe width not equal to foot width. Footwear that was too narrow by one shoe size or width fitting was common (31.0%-78.0%) but too wide was rare (2 studies: 1.0% too wide where 100% had DM or 64.6% where 9% had DM). DFU was more likely in older people who wore either incorrect size or inappropriate footwear (n = 219, 100.0% DM, OR 1.7, p = 0.001) or incorrect length or width footwear (n = 440, 58.4% DM, OR 5.1, p = 0.02), but not in those with incorrect shoe width (n = 65, 9.0% DM, OR 0.75, p = 1.0).

CONCLUSIONS

It is unclear how much space the at-risk forefoot requires. Standardised methods are needed to establish the accuracy and reliability of foot and footwear measuring tools, and to evaluate footwear fit, given their relationship with the clinical outcome.

© 2025 The Author(s). Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.