Footwear plays a crucial role in the health and well-being of individuals with diabetes, particularly concerning the risk of foot ulceration. A recent systematic review published in Diabetic Medicine by Petra J. Jones, David G. Armstrong, Robert Frykberg, Melanie Davies, and Alex V. Rowlands, delves into this critical issue, examining the link between improperly fitting footwear (IFF) and diabetes-related foot ulceration (DFU).
Key Findings
The review comprehensively analyzed data from multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar, focusing on English-language, peer-reviewed studies. Out of 4318 results, 45 studies were shortlisted, and 10 met the stringent inclusion criteria. The findings highlight several important points:
- Association Between IFF and DFU: While some evidence suggests a significant association between IFF and DFU, this connection is not universally established across all studies. Only three out of ten studies found a statistically significant link, with the percentage of DFU cases attributed to IFF ranging from 15.0% to 93.3%.
- Quality of Studies: The quality of the studies varied, with most being rated as fair or good. However, the risk of bias was a concern in some studies, affecting the reliability of the results.
- Definitions and Measurements: A critical limitation identified was the inconsistency in defining IFF and the methods used to assess footwear fit. This heterogeneity complicates the comparison of results across different studies.
- Ulcer Location: Among the few studies that reported ulcer locations related to IFF, the majority of ulcers were found at the plantar hallux/toes (70%) and plantar metatarsal heads (10%).
- Need for Further Research: The review emphasizes the necessity for more rigorous research that clearly defines IFF, systematically records footwear assessments, and considers ulcer location and physical activity levels. Understanding the underlying reasons for wearing IFF, such as economic constraints or lack of footwear education, is also crucial.
Implications for Practice and Future Research
The findings of this systematic review underscore the importance of proper footwear in preventing DFU in people with diabetes. Healthcare providers should prioritize patient education on appropriate footwear choices and consider economic factors that may influence footwear decisions.
Future research should aim to standardize the definition and assessment of IFF and explore innovative solutions to address the barriers to wearing properly fitting footwear. This could involve interdisciplinary approaches combining insights from podiatry, biomechanics, and social sciences to develop comprehensive strategies for preventing DFU.
For those interested in exploring this topic further, the full article is available in Diabetic Medicine. You can access it here.
Citation
Jones, P. J., Armstrong, D. G., Frykberg, R., Davies, M., & Rowlands, A. V. (2024). Footwear fit as a causal factor in diabetes-related foot ulceration: A systematic review. Diabetic Medicine. https://doi.org/10.1111/dme.15407
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