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The Role of Footwear in the Prevention of Diabetic Foot Complications: The State of the Art

  • Luigi Uccioli
  • Claudia Giacomozzi
Chapter
Part of the Contemporary Diabetes book series (CDI)

Abstract

Main goal of human foot evolution was to allow safe and effective barefoot motion on natural grounds. Footwear came afterwards, to protect the foot from extreme environmental conditions, to improve walking and running performance, and to cope with challenging surfaces also including new artificial substrates. But while on the one side shoes and insoles—i.e., footwear—act beneficially on the foot, on the other side they may limit foot function and render the foot itself more fragile and less prone to adaptation. This may lead the shod foot to unnaturally concentrate peak pressures under small areas at heel, forefoot, and hallux. Such a potentially dangerous condition may likely happen in diabetic patients with long-term complications, such as peripheral neuropathy, which deeply modify foot structure, foot function, and the resulting gait. Without proper protection, such patients are made vulnerable and at risk of foot ulceration. Unsuitable footwear may precipitate this condition and may be responsible for the new appearance or the recurrence of a foot ulcer. Research efforts during the last 50 years helped to better understand the criteria to take into account when prescribing or making proper footwear and/or plantar orthoses to: prevent diabetic foot ulceration (primary prevention); manage healing of an active ulcer; and prevent ulcer recurrences (secondary prevention). However, despite these huge advances in knowledge, recent literature still claims the lack of strong evidence about clinical efficacy of diabetic footwear especially in preventing first ulcer occurrence. Main reasons for that, among which the still poor adherence to treatment, are presented and discussed in the following, together with a literature review of the most recent peer-reviewed studies and position papers, to bring attention on the main causes for the still limited success of footwear intervention in diabetes and on a desirable improvement of diabetic foot care.

Keywords

Diabetes Foot–ankle complex Footwear recommendations Ulceration Primary prevention Secondary prevention Partial amputation Charcot’s foot Foot aids Active lesions Shear stress Plantar pressures Foot orthoses Foot structure Footwear prescription Proper shoe fitting Footwear treatment Foot walker Offloading 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Luigi Uccioli
    • 1
  • Claudia Giacomozzi
    • 2
  1. 1.Department of Systems MedicineTor Vergata University HospitalRomeItaly
  2. 2.Department of Cardiovascular, Dysmetabolic and Aging-Associated DiseasesItalian National Institute of HealthRomeItaly

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