63% Of Diabetics Risk Serious Foot Problems By Wearing Wrong Sized Shoes

Only one in three adults with diabetes wears shoes that fit properly, exposing themselves to serious foot problems that could lead to amputation, a new British study shows. The researchers measured the feet and shoes of 100 adults with diabetes at a diabetes clinic. Published to coincide with World Diabetes Day (14 November) the study, by the University of Dundee, has been welcomed by an expert in podiatry. She says that ulceration can have serious implications for patients and health services, including impaired quality of life, increased amputation risk and even elevated death rates.

A hundred patients aged 24 to 89 volunteered to take part in the shoe-size study carried out at a general diabetic clinic at Ninewells Hospital Medical School in Dundee, Scotland.

Patients who were also attending specialist foot clinics were excluded, as were patients who had problems standing or were wearing specially provided footwear.

"All the patients had their feet fully examined and measured while they were both sitting and standing" explains co-author Dr Graham Leese.  The team found that 63 per cent of the patients were wearing the wrong-sized shoes. For example, 45 per cent were wearing the wrong width fitting, with the majority being too narrow.

"When people stand up their feet change shape as the arch of the foot flattens and the foot becomes wider and longer" explains Dr Leese. "Taking both these sets of measurements into account, only 37 per cent of the patients were actually wearing the right-sized shoes.

"Interestingly, patients who didn’t have problems with lack of feeling in their feet a common problem with diabetes – were just as likely to wear badly fitting shoes as those who did.  "We also discovered that almost a third of the patients said they took a different shoe size to the one they were actually wearing. This isn’t helped by the fact that shoe sizes vary from make to make."

45 per cent of the volunteers had experienced previous problems with their feet, including ulcers, callouses, bunions, corns or swelling. Despite this, 22 per cent never checked their own feet and only 29 per cent checked them daily.

Foot problems could be reduced by adults being offered foot-measuring services in shoe shops, say the researchers. They would also like to see manufacturers developing standardized shoe sizes and expanding the range of length and width fittings that they offer, especially for patients who have no feeling in their feet.

Practice Pearl:  Talk to patients about footwear as part of diabetes foot care.
November 2007 issue of IJCP, the International Journal of Clinical Practice.

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FACT:

Diabetes death rates higher in black youths: During the past two and a half decades, consistent racial disparities have existed in diabetes mortality among young Americans, with death rates for black youths significantly higher those for white youths. 

In the United States, diabetes affects 18 per 10,000 children and adolescents younger than age 20. CDC investigators analyzed deaths between 1979 and 2004 with an underlying cause of diabetes among US children and teens 1 to 19 years old.  See This Weeks’ Item # 2