Evaluation of Footwear Fit Guidelines Under Pressure in At-Risk Feet

Background: Incorrectly fitted shoes are implicated in one in five diabetes related foot ulcers, yet there is a lack of consensus around the clinical definitions of fit.

Recommended toe gaps vary widely from 6 mm to 20 mm depending on the footwear guidance referred to but no research to date has assessed their effectiveness in minimising in-shoe pressures.

Aims: To conduct a pilot study in people with diabetes and neuropathy to compare mean pressures in shoes fitted according to different footwear guidelines.

By comparing pressures in 'correctly fitting' shoes as proscribed by these guidelines, we can carry out the first study assessing their effectiveness in minimising pressure. Investigation Plan: Footwear and foot dimension assessments using specialist equipment including digital calipers.

The ambulatory and standing in-shoe pressures of 60 people with diabetes and neuropathy will be assessed via Pedar pressure monitoring insoles, and pace/gait monitored using stopwatches and GENEActiv accelerometers.

Neuropathy is confirmed by using both 10-g monofilament at three sites and VPT measured at the hallux as >25V using a biothesiometer, with measurement of HbA1c, insulin resistance and body composition.

Incorrect fitting is determined by reference to Touvaruela-Carrión, Chantelau and Gede and Diabetic Foot Australia Guidelines.