We recently conducted an audit of our outpatients footwear, where the general demagraphics were 65% DM, 35% PVD. 55% Male 45% Female.
We looked at shoe style, material, Closure and fit, and made assessment of the footwear's general appropriatness, based upon "good shoe guidelines" and the appropriatness of the shoe to the patient using both "good shoe guidlines' and patient charecteristics (eg foot lessions, Phx ulcer, -ve 10 filament, no pulses etc.)
The results were interesting in that:
Gender
There was no difference between males and females in the Appropriateness of shoe to the patients, but women were more likely to wear footwear lower in General Appropriateness.
Women were more likely to wear footwear without fastenings, and of poorer fit with 20% of their shoes considered too small. This was further reflected with females having twice the number of apical corns than males.
Diabetes
Patients with diabetes made acceptable footwear choices only 55% of the time. They were found to be make poorer footwear choices, with 30% wearing shoes with no form of closure. The general appropriateness of the shoes were lower than average and 40% of patients were wearing shoes than were considered inappropriate or damaging to the patients foot health.
Vascular Disease
Patients with vascular disease (either PVD or venous insufficiency) were more than twice as likely to were shoes considered damaging to there feet.
So why did this happen despite our repeated education of our patients? It may be to do with the poor funding of specialist footwear, but has more to do with patients not wanting to spend more than $20 on shoes. Often the signs of an at risk foot are not clearly evident to the patient, and they are not aware that their neuropthy has progressed, despite education and filament testing etc. and believe that the shoe style they have been wearing for the last 10 years are still OK. I Think
In defence most of my older DM T2 women have a foot width fitting of >E. The average for Australian women is D. It is very difficult to buy shoe wear which has an appropriate width fitting.The Bannock's measuring device only measures to 3E in men. You have to really depend upon the patient informing the shoe fitter they are diabetic [with PN], the expertise of the fitter and the availability of width and depth shoe wear [which is easily obtainable with out buying MGS or a sports walking shoe].
As diabetic foot educators I believe we have to spend more time with these basics to prevent the blister which eventuates into a amputation.
I am a healthy 52 year old and I have limited choice with D fittings.
Living in southern Queensland gives us more scope with the casual leisure style range but it must be difficult with more climatic variation.
Just a thought.
Kind regards,
Jo