63 per cent of diabetics risk serious foot problems by wearing the wrong-sized shoes

More than six out of ten people with diabetes are walking around in the
wrong-sized shoes, exposing themselves to serious foot problems that
could lead to amputation, according to research in the November issue of
IJCP, the International Journal of Clinical Practice.

Published to coincide with World Diabetes Day (14 November) the study,
by the University of Dundee, has been welcomed by an expert in podiatry.
She says that ulceration can have serious implications for patients and
health services, including impaired quality of life, increased
amputation risk and even elevated death rates.

The United Nations, which passed a landmark resolution in December 2006
recognising diabetes as a chronic, debilitating and costly disease, has
designated World Diabetes Day as an official United Nations Day for the
first time in 2007.

And the World Health Organization has said that the number of people
suffering from diabetes could double to 366 million by 2030 and that 80
per cent of diabetic foot amputations could be prevented.

A hundred patients aged 24 to 89 volunteered to take part in the
shoe-size study carried out at a general diabetic clinic at Ninewells
Hospital Medical School in Dundee, Scotland.

Patients who were also attending specialist foot clinics were excluded,
as were patients who had problems standing or were wearing specially
provided footwear.

"All the patients had their feet fully examined and measured while
they were both sitting and standing" explains co-author Dr Graham
Leese, a consultant at the clinic, which forms part of University of
Dundee.

The team found that 63 per cent of the patients were wearing the
wrong-sized shoes. For example, 45 per cent were wearing the wrong width
fitting, with the majority being too narrow.

"When people stand up their feet change shape as the arch of the foot
flattens and the foot becomes wider and longer" explains Dr Leese.
"Taking both these sets of measurements into account, only 37 per
cent of the patients were actually wearing the right-sized shoes.

"Interestingly, patients who didn't have problems with lack of
feeling in their feet - a common problem with diabetes - were just as
likely to wear badly fitting shoes as those who did.

"We also discovered that almost a third of the patients said they
took a different shoe size to the one they were actually wearing. This
isn't helped by the fact that shoe sizes vary from make to make."

45 per cent of the volunteers had experienced previous problems with
their feet, including ulcers, callouses, bunions, corns or swelling.
Despite this, 22 per cent never checked their own feet and only 29 per
cent checked them daily.

Foot problems could be reduced by adults being offered foot-measuring
services in shoe shops, say the researchers. They would also like to see
manufacturers developing standardised shoe sizes and expanding the range
of length and width fittings that they offer, especially for patients
who have no feeling in their feet.

Podiatry expert Andrea Parnes, from the University of Ulster, agrees.
She points out that, given the scale of the problem, it would make
commercial sense for manufacturers to work with health professionals to
expand their existing ranges.

In her accompanying editorial she calls for greater research into the
problem, pointing out that the study also raises concerns about patients
with conditions like rheumatoid arthritis.

The current issue of IJCP also includes a special supplement, which
expresses support for the United Nation's resolution on diabetes and
highlights practical examples that have been shown to improve diabetes
care.

These range from raising government awareness worldwide to empowering
patients at grassr
oots level.