Science or Tradition? Strength of Evidence for Footwear Fit Guidelines From Peer-Reviewed Studies of People With Diabetes-A Foot in Diabetes UK Systematic Review.

BACKGROUND

Footwear fit advice for patients and people with diabetes varies significantly. A review of the strength of evidence for footwear fit standards developed in peer-reviewed studies is urgently needed both to inform future research and guidelines.

METHODS

We performed a systematic review to summarise and evaluate strength of evidence (GRADE) and risk of bias (Newcastle-Ottawa Scale) of footwear fit standards in peer-reviewed research studies involving people with diabetes through a search of Medline, Scopus, Embase and Web of Science databases.

RESULTS

Wearing incorrect shoe size increased DFU risk by up to 10 times (OR 1.7, p = 0.001 to OR 10.4, p < 0.001) based on 4 studies (risk of bias: poor (n = 3) to good (n = 1), but GRADE strength of evidence was Low to Moderate). GRADE strength of evidence for recommended footwear length, width and depth were very low to low. No studies were found examining DFU risk or in-shoe pressure in shoelace alternatives, varying toe box shapes, heel width or height.

CONCLUSION

Strength of evidence for current footwear fit guidelines is limited. Footwear fit guidance should currently be based on assessing adequate shoe size, with further research required to determine quantitative ranges for toe gaps, etc.