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Diabetic patient's compliance with bespoke footwear after healing of neuropathic foot ulcers
1Medical Department of Nutrition and Metabolic Diseases, Heinrich-Heine University of Düsseldorf.
Objectives:
To define personal attributes and factors associated with compliance to wearing protective footwear in severely neuropathic diabetic patients with a history of foot ulceration.
Design:
Case-control study.
Setting:
Diabetic foot clinic.
Subjects:
85 patients regularly attending the foot clinic were assessed after healing of neuropathic foot ulceration.
Intervention:
Recommendation of wearing cushioned bespoke shoes instead of normal shoes, prescription of up to 2 pairs of bespoke shoes on request.
Main Outcome Measures:
Clinical characteristics and attitudes of compliant patients wearing bespoke shoes (cases) versus non-compliant control patients wearing normal shoes on a random day.
Results:
The 51 case patients were significantly older and more often amputated than the 34 controls; they more frequently rated their feets' sickness and their overall health status as less favourable than did controls (p < 0.05). The controls, however, were more often on renal replacement therapy. Although the appearance of bespoke shoes was disliked by all of the patients, and 47% of the cases and 100% of the controls would favour normal shoes for cosmetic reasons, all case patients wore their bespoke shoes according to the physicians recommendation, as compared to 26% of the controls (p < 0.01).
Conclusion:
Differences in age, perception of foot abnormalities and health status, and other distressing medical conditions (i.e. renal replacement therapy, previous minor amputations) in addition to cosmetic reasons may affect the patients' compliance with bespoke protective footwear.