Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: A cross-sectional study

Chicharro‐Luna, Esther; Ortega-Ávila, Ana Belén; Aranzazu, Requena-Martínez; Gijón-Noguerón, Gabriel

doi:10.1016/j.pcd.2020.08.009

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…Chicharro-Luna et al [22] also used this 1.0-1.5 cm toe gap to assess footwear length within a convenience sample of 108 people with diabetes, 17 of which had neuropathy, and all of which had a diabetes duration of more than five years. Among the 160 items of closed footwear (as opposed to open toe sandals) only 65 (40.6%) were of correct length, with 63 (39.4%) wearing footwear that was too large (> 1.5 cm toe gap) and 32 (20%) wearing footwear that was too small (< 1.0 cm toe gap).…”

Section: Discussion Of Toe Gap Within Footwear Assessmentsmentioning

confidence: 99%

“…The minimum toe gap applied to assess footwear worn by people with diabetes is typically 1 cm ( n = 6) [20–22, 24, 26, 27] but in some instances a more generous rule of thumb is applied [23, 25] presumably intended as an approximate measure. In Litzelman [25] 352 patients were included in evaluation of footwear characteristics as predictors of DFU, of whom 63 ulcerated.…”

Section: Discussion Of Toe Gap Within Footwear Assessmentsmentioning

confidence: 99%

“…Currently, the IWGDF guidelines do not specify the most appropriate methodology for measuring either the foot or the more difficult to access internal footwear length within a shoe. In the 8 studies of shoe fit we found that of those focused on people with diabetes, four employed a Brannock or similar device (Table 2), using slide rules to position and measure the foot [21, 22, 24, 26] (as recommended by the DFAGF [33]) to obtain this distance from the heel to longest toe. In two studies a rather literal rule of thumb was used to estimate toe gap presumably by pressing on the toes [23, 25].…”

Section: Discussion Of Toe Gap Within Footwear Assessmentsmentioning

confidence: 99%

“…Studies were assessed by title and abstract to determine eligibility from which 15 studies were selected with 10 excluded after full paper review. A further 12 full papers were identified through reference analysis of which 3 were included, totalling 8 relevant studies (Table 1) [20][21][22][23][24][25][26][27] which formed the basis of this narrative review. Reasons for exclusion included limited discussion of quantifiable physiological fit (n = 9), discussion of fit only in healthy participants (n = 1), limited numbers of people with diabetes or unknown whether any have diabetes (n = 2), no discussion of toe gaps, only footwear size (n = 5) or where the focus was on foot change and morphology rather than incorrect fit (n = 2).…”

Section: Methodsmentioning

confidence: 99%

“…In this instance, it was adapted to also measure internal footwear length rather than shoe size but a device specifically for internal foot length measurement is now available (SATRA STD 225 M). Finally, in Chicharro-Luna et al [22], a CEGI instrument was used which is capable of measuring both the foot and the internal footwear length using a plastic gauge on the side of the device. Some space within a shoe may not be accessible to the toes and this should not be included in any measurements.…”

Section: Toe Gap Measurementmentioning

confidence: 99%

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Toe gaps and their assessment in footwear for people with diabetes: a narrative review

Jones

Bus

Davies

et al. 2020

Journal of Foot and Ankle Research

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Background Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal footwear length available to the foot. We summarised the literature on toe gaps in studies assessing footwear worn by people with diabetes, the methods used to measure both foot length and internal footwear length and identify ambiguities which may impact on toe gap assessment in clinical practice, and suggest pragmatic solutions. Methods The Google Scholar database was searched to April 2020 for peer-reviewed studies using keywords related to incorrectly fitting or ill-fitting and diabetes, foot and ulcer which returned 979 results. Included studies within this narrative review encompassed toe gap measurement to assess footwear worn by people with diabetes. Results A total of eight studies were included after full paper review. Toe gap ranges as used in assessments of footwear worn by people with diabetes vary, with a minimum of 1.0–1.6 cm and a maximum of 1.5–2.0 cm, as do methods of measuring internal footwear length. Only three published studies suggested possible measuring devices. Conclusions Toe gap ranged as used when assessing footwear fit in people with diabetes vary and a gold standard device for internal footwear length measurement has yet to emerge. International guidelines provide welcome standardisation, but further research is needed to evaluate both the effect of toe gap ranges upon pressure, plantar stress response and ulceration and available measuring devices to facilitate development of toe gap measurement protocols that may further enhance consistency in practical assessments.

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Section: Discussion Of Toe Gap Within Footwear Assessmentsmentioning

confidence: 99%

Section: Discussion Of Toe Gap Within Footwear Assessmentsmentioning

confidence: 99%

Section: Discussion Of Toe Gap Within Footwear Assessmentsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Toe Gap Measurementmentioning

confidence: 99%

See 3 more Smart Citations

Toe gaps and their assessment in footwear for people with diabetes: a narrative review

Jones

Bus

Davies

et al. 2020

Journal of Foot and Ankle Research

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Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy

Jorgetto

Oggiam

Gamba

et al. 2022

J Diabetes Metab Disord

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

Jones,

Armstrong,

Frykberg

et al. 2024

Diabet Med

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AimsIncorrectly 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.MethodsWe 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.Results4318 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.ConclusionsThere 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.

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Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: A cross-sectional study

Cited by 6 publications

References 30 publications

Toe gaps and their assessment in footwear for people with diabetes: a narrative review

Toe gaps and their assessment in footwear for people with diabetes: a narrative review

Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy

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

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