Low Adherence to Diabetic Footwear Means Trouble

Patients wear custom made shoes less at home and on weekends….

A 7-day diabetic footwear adherence study was conducted on 120 patients who had a diagnosis of diabetes, loss of protective sensation, a prior healed foot ulcer, and a prescription for custom-made footwear.

In order for researchers to monitor how often patients wore their custom made shoes, special temperature based monitors where placed in patients’ shoes. Also, patients wore a step count monitor on their ankle.

Of the 107 patients with at least 4 days of step data, footwear adherence was 71% (range, 10% – 100%). Patients wore the shoes significantly less often while at home (P < .001), but they took significantly more steps while there compared with outside the home (P < .001). Patients took an average of about 4,000 steps inside the home and 2,600 steps outside.

About 59% of total daytime hours were spent wearing their prescription footwear, with only 29% of the patients wearing the shoes for more than 80% of the daytime, the authors report.

“It is clear that to be effective in ulcer prevention, prescription footwear should be worn by the patient, in particular when being ambulant. Because annual ulcer recurrence rates are high, up to 40% found in 1 study, poor adherence may be a factor in this outcome,” the authors write.

“Interventions aimed to increase adherence should primarily target the home situation, through the prescription of special off-loading footwear for indoors,” they conclude.

https://care.diabetesjournals.org/content/early/2013/01/11/dc12-1330.abstract 

Submitted by Sara DAkroub, PharmD Candidate