Assessment of footwear among patients with diabetes mellitus: A cross-sectional descriptive study from south India

Background: Diabetic peripheral neuropathy, a well-known complication of diabetes mellitus, leads to insensate foot, prone for ulceration. Inappropriate footwear and walking barefoot increases this risk in a neuropathic foot. A diabetic foot ulcer can be very costly, affecting the quality of life adversely and also result in amputation. A well-fitting, good footwear plays an important role in preventing injury and ulceration. In this study, we aimed to assess the footwear of patients with diabetes. Materials and Methods: This study was conducted during May 2019. Alternate patients among 230 patients were selected, and 112 patients with type 2 diabetes were included. Every patient was educated regarding all aspects of diabetes. Feet of each patient were examined. Biothesiometry, monofilament, and footwear assessments were performed. Results: Among 112 patients enrolled, 69 (61.6%) were males and 43 (38.3%) females. Mean age was 60.2 +/- 11.7 years, and age ranged from 21 to 83 years. Duration of diabetes ranged from less than a year to 45 years. Of the total patients, 73 (65.17%) had significant diabetic peripheral neuropathy when assessed objectively, using biothesiometry and 10 g Semmes-Weinstein monofilament. Only 10 (8.9%) patients had footwear made of microcellular rubber. Only 15 (13.3%) wore a footwear with backstrap. Among those with neuropathy, only 4 (3.5%) had microcellular rubber (MCR) footwear with a backstrap. Optimal toe box was seen in 98 (87.5%) patients as most patients wore open footwear. Most of our patients wore footwear that was too hard, with shore value on durometry ranging from 60 to 75. Only 5 (4.46%) patients had desirable soft insole. Conclusion: No patient had an optimal footwear that fulfilled all criteria required for a foot with diabetic peripheral neuropathy. Hence, in addition to screening for neuropathy and regular checking of feet, it is also important to look at patient's footwear and make necessary amendments periodically.