Current practice in prescribing footwear and insoles to reduce the risk of neuropathic plantar forefoot ulceration and re-ulceration in people with diabetes.

BACKGROUND

Footwear and insoles are frequently used to offload the neuropathic diabetic foot at risk of ulceration and re-ulceration. This study aims to explore the prescription habits of Australian pedorthists and the variations in footwear and insole design due to variations in foot pathology, comorbidities and patient-specific factors consideration.

METHODS

An online survey link was sent to Australian pedorthists (n = 42), who were asked to answer questions relating to four hypothetical cases exploring current footwear and insole prescribing habits. Qualtrics research and data analysis software was used for the online survey and data analysis tool.

RESULTS

Custom-made footwear was commonly prescribed in more complex cases, with recommendations ranging from 47% to 80% across scenarios (e.g., 80% in Case-4). In simpler cases, prefabricated medical-grade footwear with modifications was more frequently recommended (e.g., 53% in Case-1). Custom-made insoles were recommended by 84% to 100% of participants across all cases. Variations in prescriptions were largely influenced by differences in pathology, comorbidities, and individual patient preferences. Common barriers to patient adherence included concerns about appearance, bulkiness, and difficulty putting on or removing the footwear. To address these, pedorthists employed strategies such as involving family members in design choices, offering dual-purpose footwear (e.g., for indoor and outdoor use), incorporating culturally or gender-sensitive designs, and using in-shoe pressure mapping to demonstrate clinical benefits.

DISCUSSION AND

CONCLUSION

Australian pedorthists follow national and international guidelines for footwear and insole prescriptions with some variations when they encounter patient-specific factors such as preferences and lifestyle. The majority of them follow the best practices when evaluating the efficacy of the recommended devices, such as in-shoe pressure mapping systems. They also employ various practical techniques to increase adherence towards improved patient outcomes by engaging family or partners and through motivational interviews and interdisciplinary team approaches.