Australia‘s new guideline on footwear for people with diabetes
By Wolfgang Best
An international working group has updated the Australian guideline on footwear for people with diabetes. For the update the authors reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline.
Long term complications in people themselves with diabetes frequently manifest in foot problems. Diabetes is the primary cause of nontraumatic amputation in the Western World. The use of appropriate footwear among patients with diabetes mellitus and those with diabetic foot problems is an important part of an overall treatment program.
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 of adherence to wearing footwear. For the development of the guideline the authors followed the classification of the National Health and Medical Research Council (NHMRC) which divides people with diabetes in three categories: Low-risk of foot ulceration; intermediate-risk of foot ulceration; high-risk of foot ulceration. On this basis 10 key recommendations were formulated to guide health professionals managing people with diabetes in choosing the most appropriate footwear for the person’s specific foot risk needs (see box). The authors do not only give recommendations but also provide the rationale which is based on the best available evidence from contemporary studies investigating footwear interventions, international guidelines and expert opinion.
The authors also stress the importance of foot screening to identify risk factors at an early stage and that the specific footwear requirements are closely related to an individual’s foot risk status. Not only the physician has to know the risk status. The patients too need to be aware of their risk status. Early education on the importance of adequate footwear for foot health is important for all people with diabetes to ensure the footwear is being used.
The updated Australian guideline provides a comprehensive overview of all aspects concerning the footwear for people with diabetes. The fact that the guideline is based on the best available evidence might make it a model for others countries who are seeking for guidelines to improve the provision of footwear for patients with a diabetic foot syndrome.
For all people at-risk of foot ulceration
- Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet.
- Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction.
- 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
- 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.
Review prescribed footwear every three months to ensure it still fits, protects, and supports the foot for people with diabetic foot ulceration.
For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers.
Reference:
Jaap J. van Netten, Peter A. Lazzarini, David G. Armstrong, Sicco A. Bus, Robert Fitridge, Keith Harding, Ewan Kinnear, Matthew Malone, Hylton B. Menz, Byron M. Perrin, Klaas Postema, Jenny Prentice, Karl-Heinacz Schott and Paul R. Wraight: Diabetic Foot Australia guideline on footwear for people with diabetes; Journal of Foot and Ankle Research (2018) 11:2
