Diabetic Foot Australia guideline
Table 2: Recommendations on footwear for people with diabetes
# Recommendations
For all people at-risk of foot ulceration
1 Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet
2 Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction
3
Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent
foot ulceration
For people at intermediate- or high-risk of foot ulceration
4
5
6
7
8
Instruct people with diabetes at intermediate-or high-risk of foot ulceration to obtain footwear from an appropriately trained
professional to ensure it fits, protects and accommodates the shape of their feet
Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both
indoors and outdoors
Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check
their:
a. footwear, each time before wearing, to ensure that there are no foreign objects in the footwear, or penetrating, the soles
b. feet, each time their footwear is removed, to ensure that there are no signs of abnormal pressure, trauma or ulceration
For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include
custom-made in-shoe orthoses or insoles
For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or
insoles with a demonstrated plantar pressure reducing effect at the high-risk areas
9 Review prescribed footwear every three months to ensure it still fits, protects, and supports the foot
For people with diabetic foot ulceration
10
For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate
offloading devices to heal these ulcers
and depth (and consequently adequate girth,
i.e. adequate volume) [10, 15, 16, 32, 33] . A particular
emphasis may need to be placed on the toe
box of the shoe that should be consistent
with the shape of the forefoot and toes of the
person. An enclosed heel with a stabilising
heel counter is recommended. Open-heel
footwear can result in direct trauma injury
to the heel and may require a person to claw
their toes in order to keep the footwear fixed
to their feet, further increasing the repetitive
stress under their forefoot, and in turn the
risk of ulceration. Adequate closure of the
footwear is needed, to prevent the foot from
sliding forwards and thus causing shear injury
to the toes or plantar foot [36] . All features in
Table 3 should be considered in combination,
as their intended function is closely related
and changes to one feature may affect other
features and overall function [10, 15, 16, 32, 33] .
People at low-risk of foot ulceration can
usually be safely accommodated in a wide
range of off-the-shelf footwear without
specific requirements, provided the footwear
is correctly fitted and appropriate for the
activity to be undertaken [10, 15, 16, 32, 33] . For
people at intermediate- or high-risk of foot
ulceration, see recommendations 4-9. When
new footwear is provided to a person with
diabetes at low-risk of foot ulceration, advise
them that a “wear-in” period may be needed
where they slowly increase the number of
hours per day the footwear is used, and that
Current Pedorthics | September-October 2020
47