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An Integrated Personalized Multimodal Intervention Improves Adherence to Wearing Custom-Made Footwear in People With
Lisa E Vossen1,2, Jaap J Van Netten1,2, Chantal M Hulshof1,2
1Department of Rehabilitation Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Diabetes Care
|June 5, 2026
Summary
An integrated personalized intervention significantly improved footwear adherence in people with diabetes at high risk of foot ulcers. This approach enhances adherence, crucial for preventing serious complications.
Area of Science:
- Podiatry
- Diabetology
- Public Health
Background:
- Diabetes-related foot ulcers represent a significant health burden.
- Adherence to wearing custom-made footwear is critical for ulcer prevention.
- Existing interventions to improve footwear adherence in high-risk individuals are limited.
Purpose of the Study:
- To assess the effectiveness of an integrated personalized multimodal intervention on footwear adherence in people with diabetes at high risk of ulceration.
Main Methods:
- A multicenter randomized controlled trial involving 126 participants with diabetes and a history of foot ulcers.
- Comparison of usual care (guideline-based footwear, education, podiatric care) with enhanced treatment (additional specialized footwear, structured education, motivational interviewing).
- Primary outcome: footwear adherence measured objectively at 6 and 12 months; secondary outcome: shoe-wearing time.
Main Results:
- Enhanced treatment group showed significantly higher footwear adherence at 6 months (75% vs 56%) and 12 months (58% vs 49%) compared to usual care.
- Structured education and provision of indoor-specific footwear led to significant increases in daily shoe-wearing time.
- The intervention demonstrated a 34% relative increase in adherence at 6 months (P < 0.001).
Conclusions:
- An integrated personalized multimodal intervention can significantly improve footwear adherence in individuals with diabetes at high risk for foot ulcers.
- This intervention strategy offers a promising approach to enhance adherence and potentially reduce ulcer recurrence.
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