Diabetic foot: Footwear in a management programme

Abstract

Abstract Diabetic foot disease carries a major global health and socioeconomic burden. Most ulcers and amputations may be preventable if addressed early with patient education, good foot care, and attention to footwear. Multiple guidelines exist with regards to stratification of risk and choice of shoes, therapeutic footwear (TF), and offloading devices. A review of available literature suggests that low risk groups may use off-the-shelf footwear, providing they are adequately educated in optimal shoe selection. Intermediate risk groups should have specialist input and consideration of TF. High risk groups should be managed with pressure-relieving TF. In patients with an active diabetic foot ulcer, offloading devices are indicated, with non-removable knee-high devices as the gold standard treatment. Patient compliance remains a challenge to optimal management. This article seeks to outline current evidence and consensus-based guidance with regards to footwear use in the prevention and treatment of the diabetic foot.