Footwear fit as a causal factor in diabetes-related foot ulceration: A systematic review.

David G Armstrong, Petra J Jones, Alex V Rowlands, Melanie Davies, Robert Frykberg

Journal: Diabetic medicine : a journal of the British Diabetic Association 2024;41(10):e15407

PMID: 39012919

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Abstract

AIMS

Incorrectly fitting footwear (IFF) poses a risk of trauma to at-risk feet with diabetes. The aim of this systematic review was to summarise and assess the evidence that IFF is a statistically significant cause of ulceration.

METHODS

We searched PubMed, Scopus, Web of Science and Google Scholar for English-language peer-reviewed studies reporting the number or percentage of people with diabetes-related foot ulceration (DFU) attributed to wearing IFF and included a physical examination of the footwear worn. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa scale.

RESULTS

4318 results were retrieved excluding duplicates with 45 studies shortlisted. Ten studies met the inclusion criteria with most rated as fair (n = 6) or good (n = 3). There is some evidence that DFU is significantly associated with IFF, but this is limited: only 3 of 10 included studies found a statistically significant percentage of those with DFU were wearing IFF or inappropriate footwear which included fastening, material, type or fit (15.0%-93.3%). Risk of bias in these three studies ranged from 'fair' to 'poor'. IFF definitions were often unreported or heterogeneous. Only one study reported IFF-related ulcer sites: 70% were at plantar hallux/toes and 10% at plantar metatarsal heads.

CONCLUSIONS

There is some evidence that IFF is a cause of DFU, but further research is needed, which defines IFF, and methodically records footwear assessment, ulcer location and physical activity. Researchers need to uncover why IFF is worn and if this is due to economic factors, a need for footwear education or other reasons.

Address: Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.; Keck School of Medicine, University of Southern California, Los Angeles, California, USA.; Midwestern University, Glendale, Arizona, USA.; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.; Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.

DOI: 10.1111/dme.15407

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MeSH Terms: Humans, Shoes, Diabetic Foot