Diabetic Foot Australia guideline
and caregivers) to check their footwear, each
time before wearing, to ensure that there are no
foreign objects in, or penetrating, the footwear;
and check their feet, each time their footwear is
removed, to ensure there are no signs of abnormal
pressure, trauma or ulceration.
(7) For people with a foot deformity or pre-ulcerative
lesion, consider prescribing medical grade
footwear, which may include custom-made inshoe
orthoses or insoles.
(8) For people with a healed plantar foot ulcer,
prescribe medical grade footwear with custommade
in-shoe orthoses or insoles with a demonstrated
plantar pressure relieving effect at
high-risk areas.
(9) Review prescribed footwear every three months
to ensure it still fits adequately, protects, and
supports the foot.
(10) For people with a plantar diabetic foot ulcer,
footwear is not specifically recommended for
treatment; prescribe appropriate offloading
devices to heal these ulcers.
Conclusions
This guideline contains 10 key recommendations
to guide health professionals in selecting the most
appropriate footwear to meet the specific foot risk
needs of an individual with diabetes.
Background
Diabetic foot ulcers are a costly complication
of diabetes, reducing people’s quality of
life, and increasing morbidity, mortality
and healthcare expenditure [1–4] . The annual
incidence of foot ulcers in people with
diabetes is approximately 2%, both globally
[3]
and in Australia [5] , and the lifetime risk
is between 19% and 34% [6] . Additionally,
diabetic foot ulcers are the leading cause
of lower extremity amputations and cause
approximately 2% of all hospitalizations [3–5,
7, 8]
. Therefore, the prevention of diabetic foot
ulcers is of paramount importance.
Diabetic foot ulcers are typically caused by
repetitive stresses (shear and pressure) on the
foot in the presence of the diabetes-related
complications of peripheral neuropathy or
peripheral artery disease, and their healing
is often complicated by the development of
infection [9–13] . Use of inappropriate footwear
or walking barefoot typically increases the
magnitude of the local mechanical repetitive
stresses on the foot that are leading causes
of the development of diabetic foot ulceration
[9–12]
. Thus, it is recommended that people with
diabetes wear appropriate footwear designed
to reduce repetitive stresses at all times, to
help prevent diabetic foot ulceration [14, 15] .
In 2013, the Australian Diabetes Foot Network
published one of the first nationwide practical
guidelines on the provision of footwear for
people with diabetes [16] . Since this publication,
pivotal new studies [9, 17–30] and international
guidelines [10, 14, 15] have been published on
footwear for people with diabetes. This new
literature provides a stronger evidence-base
for the effectiveness of footwear in ulcer
prevention for people with diabetes, new
data-driven directions for the prescription of
footwear, and new evidence on the importance
[9, 10, 14, 15,
of adherence to wearing footwear
17–30]
. The aim of this article is to update the
2013 Australian practical guideline [16] , and
thereby creating a new Diabetic Foot Australia
guideline on footwear for people with diabetes.
42 Pedorthic Footcare Association | www.pedorthics.org