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 grassroots level.