If the Shoe Fits, Diabetics Can Wear It

May 14, 2002

NEW YORK (MedscapeWire) May 15 -- Good-quality, properly fitting shoes may prevent diabetic foot ulcers just as well as custom therapeutic inserts and footwear, according to results of a randomized trial published in the May 15 issue of The Journal of the American Medical Association. Still, healthcare professionals should devote careful attention to routine foot care in diabetics.

"The results were surprising," lead author Gayle E. Reiber, MPH, PhD, of the Veterans Affairs (VA) Puget Sound Health Care System and the University of Washington, says in a news release. "The popular notion among foot specialists is that therapeutic shoes and inserts should be prescribed freely to all patients with diabetes and prior foot ulcers. However, this study did not provide evidence to support this practice."

In this study, researchers randomized 400 men and women with a history of diabetic foot ulcer to wear extra-depth therapeutic shoes with customized cork inserts, therapeutic shoes with non-custom polyurethane inserts, or their own shoes. Patients with severe foot deformities or other special problems who might benefit from custom-made footwear were excluded. All subjects wore specially designed slippers when not in their shoes, and all had access to good-quality healthcare, including visits every 17 weeks with a team that included a foot-care specialist.

After 2 years, ulcer rates were low in all 3 groups: 15% for those with customized inserts, 14% for those with standard inserts, and 17% for those who wore their own shoes. These rates were dramatically lower than those in earlier European studies.

According to Reiber, the extra attention given these subjects may have contributed to the overall low rate of ulcers in all 3 groups. Although careful attention by healthcare professionals may be more important than therapeutic footwear in preventing ulcers, patients with limited access to care may benefit from special footwear.

For diabetics, foot-care specialists routinely recommend "depth" shoes providing extra toe room, along with inserts, which are reimbursable by Medicare up to $318 per year. "The evidence suggests that a shift in the diabetic foot-care paradigm may be in order," says researcher Douglas C. Smith, MD, of the University of Washington.

JAMA. 2002;287(19):2552-2558

Reviewed by Gary D. Vogin, MD

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