The use of orthopaedic shoes in patients with diabetes at high risk of foot amputation and Charcot arthropathy

Aim.

To evaluate the use of orthopaedic shoes in patients with diabetes with foot ulcers and/or previous minor amputations or Charcot arthropathy (CA) and factors influencing this use.

Patients and methods.

One hundred twenty-one patients with diabetes (55 men and 66 women; 36 in the inactive stage of CA) were included. A questionnaire based on footwear was used to evaluate patients’ compliance. Daily activity and the severity of the foot deformities were recorded. Further, foot geometry and forefoot and midfoot circumferences were measured.

Results.

Fifty-eight patients did not use orthopaedic shoes. Users and non-users did not differ in terms of gender and type of diabetes. The causes of refusal included ill-fitting shoes (56%), ugly appearance (11%), traumatisation with shoes (11%), inability to walk (5%) and other causes (17%). The percentages of patients in each category of deformity severity were mild (41.2%), moderate (37%) and severe (54%. Frequency of refusal of CA vs non-CA patients: 72.2% and 43.5%; with severe deformities,70.8% vs 34%; with moderate deformities, 83.3% vs 57.2% (p < 0.05 for all). In patients with CA, the only significant parameter was the difference in the circumference of the midfoot between the affected and non-affected foot; in CA users and non-users, this parameter was 1.93 ± 1.25 vs 0.70 ± 0.83 cm, respectively (р = 0.01).

Conclusions.

The high frequency of refusing to wear orthopaedic shoes is related to severe foot deformities and the inability to accommodate them in off-the-shelf footwear. Most of the patients used orthopaedic shoes for outdoor use, but the frequency of use was low. Shoe compliance did not depend on gender but increased with ageing, low levels of daily activity and in patients with severe deformities. Patients with CA are characterised with extremely low compliance. In this group, foot parameters and other objective parameters did not rely on footwear compliance.

1. Приказ Министерства здравоохранения и социального развития Российской Федерации (Минздравсоцразвития России) от 28 июля 2011 г. №823н г. Москва. «Об утверждении классификации технических средств реабилитации (изделий) в рамках федерального перечня реабилитационных мероприятий, технических средств реабилитации и услуг, предоставляемых инвалиду, в целях определения размера компенсации за технические средства реабилитации (изделия), приобретенные инвалидами (ветеранами) за собственный счет, и (или) оплаченные за счет собственных средств услуги по их ремонту» // Российская газета, №5598, 05.10.11. [Order of the Ministry of Health and Social Development of Russian Federation (Minzdravsotsrazvitiya Rossii) on 28 July 2011. №823n Moscow. “Ob utverzhdenii klassifikatsii tekhnicheskikh sredstv reabilitatsii (izdeliy) v ramkakh federal’nogo perechnya reabilitatsionnykh meropriyatiy, tekhnicheskikh sredstv reabilitatsii i uslug, predostavlyaemykh invalidu, v tselyakh opredeleniya razmera kompensatsii za tekhnicheskie sredstva reabilitatsii (izdeliya), priobretennye invalidami (veteranami) za sobstvennyy schet, i (ili) oplachennye za schet sobstvennykh sredstv uslugi po ikh remontu”. Rossiyskaya gazeta, №5598, 05.10.11. (in Russ)].

2. Постановление Правительства Российской Федерации от 7 апреля 2008 г. №240 г. Москва. «О порядке обеспечения инвалидов техническими средствами реабилитации и отдельных категорий граждан из числа ветеранов протезами (кроме зубных протезов), протезно-ортопедическими изделиями» // Российская газета, №4638, 15.04.2008. [Order of the Russian Federation Government on 7 April 2008. №240 Moscow. «O poryadke obespecheniya invalidov tekhnicheskimi sredstvami reabilitatsii i otdel’nykh kategoriy grazhdan iz chisla veteranov protezami (krome zubnykh protezov), protezno-ortopedicheskimi izdeliyami». Rossiyskaya gazeta, №4638, 15.04.2008. (in Russ)].

3. Бреговский В.Б., Залевская А.Г., Карпова И.А., и др. Эффективность программы обеспечения ортопедической обувью больных сахарным диабетом в Санкт-Петербурге: ближайшие результаты. // Сахарный диабет. – 2003. – Т. 6. – №1 – C. 38–42. [Bregovskiy VB, Zalevskaya AG, Karpova IA, et al. Programma obespecheniya ortopedicheskoy obuv’yu bol’nykh sakharnym diabetom v Sankt-Peterburge. Diabetes mellitus. 2003;6(1):38-40. (In Russ)]. doi: 10.14341/2072-0351-6043

4. Международное соглашение по диабетической стопе. Международная рабочая группа по диабетической стопе. – М.: Сервье; 2000. [Guidance on the diabetic foot. International Working Group on the Diabetic Foot. Moscow: Servier; 2002.].

5. Практические рекомендации по лечению и профилактике диабетической стопы. Международная рабочая группа по диабетической стопе. – М.: МАИ-Принт; 2012. [Practical recommendations for the treatment and prevention of diabetic foot. International Working Group on the Diabetic Foot. Moscow: MAI-Print; 2012.].

6. Brill L, Cavanagh P, Gibbons G, et al. Prevention of lower extremities amputation in patients with diabetes. Treatment of Chronic Wounds. Number 7 in a Series. 1998; p. 5-8.

7. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. The Journal of bone and joint surgery. British volume. 1992;74(4):525-527.

8. Luo G, Houston VL, Mussman M, et al. Comparison of male and female foot shape. Journal of the American Podiatric Medical Association. 2009;99(5):383-390. doi: 10.7547/0990383

9. Республиканский стандарт. Обувь ортопедическая. Термины и определения. РСТ РСФСР 741—88 Госплан РСФСР, 19.01.1988. Доступно: http://gostrf.com/normadata/1/4294816/4294816963.pdf. [Republic standard. Orthopedic footwear. Terms and conditions. RST RSFSR 741—88 Gosplan RSFSR, 19.01.1988. Available from: http://gostrf.com/normadata/1/4294816/4294816963.pdf. (in Russ)].

10. Bus SA, Waaijman R, Arts M, et al. Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial. Diabetes care. 2013;36(12):4109-4116. doi: 10.2337/dc13-0996

11. van Netten JJ, Jannink MJ, Hijmans JM, et al. Patients’ expectations and actual use of custom-made orthopaedic shoes. Clinical rehabilitation. 2010;24(10):919-927. doi: 10.1177/0269215510367991

12. van Netten J, Jannink M, Hijmans J, et al. Use and usability of custom-made orthopedic shoes. J Rehabil Res Dev. 2010;47(1):73-81. doi: 10.1682/JRRD.2009.08.0142

13. Macfarlane D, Jensen J. Factors in diabetic footwear compliance. Journal of the American Podiatric Medical Association. 2003;93(6):485-491. doi: 10.7547/87507315-93-6-485

14. Knowles EA, Boulton AJM. Do People With Diabetes Wear Their Prescribed Footwear? Diabetic Medicine. 1996;13(12):1064-1068. doi: 10.1002/(SICI)1096-9136(199612)13:12<1064::AID-DIA253>3.0.CO;2-#

15. Paton JS, Roberts A, Bruce GK, et al. Patients’ Experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: an interpretative phenomenological analysis (IPA). Journal of Foot and Ankle Research. 2014;7:16-16. doi: 10.1186/1757-1146-7-16.

16. van Netten J, Jannink M, Hijmans J,et al. Long-term use of custom-made orthopedic shoes: 1.5-year follow-up study. J Rehabil Res Dev. 2010;47(7):643-50. doi:10.1682/JRRD.2010.03.0040

17. Arts ML, de Haart M, Bus SA, et al. Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration. Journal of rehabilitation medicine. 2014;46(4):357-362. doi: 10.2340/16501977-1272

18. Schwarzkopf R, Perretta DJ, Russell TA, et al. Foot and shoe size mismatch in three different New York City populations. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons. 2011;50(4):391-394. doi: 10.1053/j.jfas.2011.04.030

19. Chantelau E, Haage P. An audit of cushioned diabetic footwear: relation to patient compliance. Diabetic medicine: a journal of the British Diabetic Association. 1994;11(1):114-116. doi: 10.1111/j.1464-5491.1994.tb00240.x

20. Williams AE, Nester CJ. Patient perceptions of stock footwear design features. Prosthetics and orthotics international. 2006;30(1):61-71. doi: 10.1080/03093640600574425