The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes.
We reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations.
We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) 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. (5) Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) 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. (8) 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 relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers.
This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.
Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d’Emden MC, Reed LF. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J. 2017;14(4):716–28.
Schaper NC, Van Netten JJ, Apelqvist J, Lipsky BA, Bakker K. International Working Group on the Diabetic Foot. Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes Metab Res Rev. 2016;32(Suppl 1):7–15. CrossRefPubMed
Crawford F, Cezard G, Chappell FM, Murray GD, Price JF, Sheikh A, Simpson CR, Stansby GP, Young MJA. Systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess. 2015;19(57):1–210. CrossRefPubMedPubMedCentral
Jia L, Parker CN, Parker TJ, Kinnear EM, Derhy PH, Alvarado AM, Huygens F, Lazzarini PA. Diabetic foot working group, Queensland statewide diabetes clinical network (Australia). Incidence and risk factors for developing infection in patients presenting with uninfected diabetic foot ulcers. PLoS One. 2017;12(5):e0177916. CrossRefPubMedPubMedCentral
Bus SA, Armstrong DG, van Deursen RW, Lewis JE, Caravaggi CF, Cavanagh PR. International working group on the diabetic foot. IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):25–36. CrossRefPubMed
Bergin SM, Nube VL, Alford JB, Allard BP, Gurr JM, Holland EL, Horsley MW, Kamp MC, Lazzarini PA, Sinha AK, Warnock JT, Wraight PR. Australian diabetes foot network: practical guideline on the provision of footwear for people with diabetes. J Foot Ankle Res. 2013;6(1):6. -1146-6-6 CrossRefPubMedPubMedCentral
Bus SA, van Deursen RW, Armstrong DG, Lewis JE, Caravaggi CF, Cavanagh PR. International working group on the diabetic foot. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):99–118. CrossRefPubMed
Lewis J, Lipp A. Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2013;1:CD002302.
Anonymous National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes): Melbourne, Australia:; 2011.
Barton CJ, Bonanno D, Menz HB. Development and evaluation of a tool for the assessment of footwear characteristics. J Foot Ankle Res. 2009;2(10):1146–2. 10
Hutchins S, Bowker P, Geary N, Richards J. The biomechanics and clinical efficacy of footwear adapted with rocker profiles--evidence in the literature. Foot (Edinb). 2009;19(3):165–70. CrossRef
Australian Diabetes Society. Diabetes Foot - The Foot Examination. 2016. https://diabetessociety.com.au/diabetesfoot/the-foot-examination.asp. Accessed April/13 2017.
Rahemi H, Armstrong DG, Enriquez A, Owl J, Talal TK, Najafi B. Lace up for healthy feet: the impact of shoe closure on plantar stress response. J Diabetes Sci Technol. 2017:1932296817703669.
Cavanagh PR. Therapeutic footwear for people with diabetes. Diabetes Metab Res. 2004;20(Suppl 1):S51–5. CrossRef
Orneholm H, Apelqvist J, Larsson J, Eneroth M. Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer. Wound Repair Regen. 2017;
Crews RT, Yalla SV, Dhatt N, Burdi D, Hwang S. Monitoring location-specific physical activity via integration of Accelerometry and Geotechnology within patients with or at risk of diabetic foot ulcers: a technological report. J Diabetes Sci Technol. 2017;11(5):899–903.
Van Netten JJ, Francis A, Morphet A, Fortington LV, Postema K, Williams A. Communication techniques for improved acceptance and adherence with therapeutic footwear. Prosthetics Orthot Int. 2017 Apr;41(2):201–4. CrossRef
Cheng Q, Lazzarini PA, Gibb M, Derhy PH, Kinnear EM, Burn E, Graves N, Norman RE. A cost-effectiveness analysis of optimal care for diabetic foot ulcers in Australia. Int Wound J. 2017;14(4):616–28.
- Diabetic Foot Australia guideline on footwear for people with diabetes
Jaap J. van Netten
Peter A. Lazzarini
David G. Armstrong
Sicco A. Bus
Hylton B. Menz
Byron M. Perrin
Paul R. Wraight
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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