Article

Older people and ill fitting shoes

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Abstract

Foot health is an important issue in older people. Inappropriate shoes increase the risk of callous and ulcer formation, as well as increasing the risk of falls. There are no data defining the size of this problem. The aim of the study was to investigate the proportion of elderly people on a general rehabilitation ward wearing incorrectly sized shoes and to look for the presence of complications. Sixty five consecutive patients (mental state questionnaire score >6) admitted to a rehabilitation ward had their foot length and width measured, and the size of their current footwear recorded. Sensation was tested with a standard 10 g monofilament. The presence of ulceration was noted. Foot pain was recorded by the patient on a visual analogue scale. Any history of diabetes mellitus, peripheral vascular disease, or peripheral neuropathy was noted. The median age of the subjects was 82 (range 64-93). Six (9%) had a history of diabetes, seven (11%) had symptomatic peripheral vascular disease, and 17 (26%) had sensory impairment. Ten patients (15%) had foot ulceration present, and 47 patients (72%) had ill fitting shoes (a discrepancy in length of more than half a British shoe size fitting or more than one British width fitting, 7 mm). Incorrect shoe length was significantly associated with the presence of ulceration (odds ratio (OR) = 10.04, p = 0.016). Presence of ulceration was significantly associated with a history of peripheral vascular disease (OR = 11.56, p = 0.008). Pain was significantly associated with incorrect shoe length (p = 0.0238) and with sensory impairment (p = 0.0314). Most older people on a rehabilitation ward wore ill fitting shoes. An association was found between ill fitting shoes and self reported pain, and between ill fitting shoes and ulcer formation. A straightforward assessment of footwear in older people could improve comfort and avoid preventable foot disorders.

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... Mean or average age was reported in all but one study [15]. One study recruited only children [16] and four studies recruited only older participants [17][18][19][20]. Three studies recruited only female participants [21][22][23], while two other studies recruited predominantly male populations, including underground coal miners [24] and war veterans [25]. ...
... The majority of included studies were cross-sectional in design [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and three studies were case-control in design [15,31,32]. All except one study reported the method for measuring the foot [32]. ...
... All except one study reported the method for measuring the foot [32]. The dimensions of the foot were measured during relaxed bipedal stance in all except two studies that measured the foot while the participant was in a seated position [18,19]. It has been suggested that feet should be measured during standing to account for changes in dimensions due to splaying of the foot after the acceptance of bodyweight [33]. ...
Article
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Background Correct footwear fitting is acknowledged as being vitally important, as incorrectly fitted footwear has been linked to foot pathology. The aim of this narrative review was to determine the prevalence of incorrectly fitted footwear and to examine the association between incorrectly fitted footwear, foot pain and foot disorders. Methods A database search of Ovid MEDLINE and CINAHL yielded 1,681 citations for title and abstract review. Eighteen articles were included. Findings were summarised under the categories of (i) children, (ii) adults, (ii) older people, (iii) people with diabetes and (iii) occupation- or activity-specific footwear. Differences in footwear fitting between sexes were also explored. Results Between 63 and 72% of participants were wearing shoes that did not accommodate either width or length dimensions of their feet. There was also evidence that incorrect footwear fitting was associated with foot pain and foot disorders such as lesser toe deformity, corns and calluses. Specific participant groups, such as children with Down syndrome and older people and people with diabetes were more likely to wear shoes that were too narrow (between 46 and 81%). Conclusion A large proportion of the population wear incorrectly sized footwear, which is associated with foot pain and foot disorders. Greater emphasis should be placed on both footwear fitting education and the provision of an appropriately large selection of shoes that can accommodate the variation in foot morphology among the population, particularly in relation to foot width.
... Active foot disease (ulcers, infection, or ischaemia) is commonly precipitated by the foot complications of previous amputations, previous foot ulcers, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity in both diabetes and nondiabetes populations [1][2][3][4]. These foot complications not only increase the risk of developing active foot disease in the community but also have been found to increase the risk of developing active foot disease, falls, and pressure injuries in the inpatient setting [3,[5][6][7][8]. Thus, it seems important for clinicians, researchers, and policy makers to understand how often these foot complications present and what other factors may precipitate them in inpatient populations. ...
... Studies investigating foot complications in inpatient populations have predominantly focused within diabetes and geriatric inpatient populations [4][5][6][7][8][9]. These studies suggest that up to 80% of diabetes inpatients, and up to 50% of geriatric inpatients, have at least one of these foot complications [4][5][6][7][8][9]. ...
... Studies investigating foot complications in inpatient populations have predominantly focused within diabetes and geriatric inpatient populations [4][5][6][7][8][9]. These studies suggest that up to 80% of diabetes inpatients, and up to 50% of geriatric inpatients, have at least one of these foot complications [4][5][6][7][8][9]. A recent systematic review of this field found previous studies have investigated either a single foot complication (such as PAD) in a representative adult inpatient population (defined as a typical hospital's inpatient population inclusive of patients admitted for any reason, with or without diabetes and of any age) or multiple foot complications in a specific inpatient population (such as all foot complications in diabetes inpatients only) [3]. ...
Article
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We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study , a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes ( p<0.01 ). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment ( p<0.01 ). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment ( p<0.02 ). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment ( p<0.02 ). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD ( p<0.05 ). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN ( p<0.01 ). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
... Poor foot care may also be an indicator of self-neglect [14,15]. Inappropriate footwear is associated with impaired balance with associated risk of falling [16] and foot disease [17]. Foot disease, defined as foot ulceration, infection, critical ischaemia and Charcot neuroarthropathy [18], represents more severe foot pathology. ...
... The rate of foot disease in this cohort is similar to other studies in sub-acute populations in Scotland and Australia that reported prevalence rates of 15% [17] and 12% [20] respectively. Diabetes-related foot disease is well recognised and improved outcomes have been achieved in recent years with interdisciplinary care [49], however in this cohort a minority of patients with foot disease and foot disease risk factors were diagnosed with diabetes. ...
... Diabetes-related foot disease is well recognised and improved outcomes have been achieved in recent years with interdisciplinary care [49], however in this cohort a minority of patients with foot disease and foot disease risk factors were diagnosed with diabetes. This is consistent with other studies of older adults [1,17,50]. Numerous other chronic medical conditions are associated with foot disease, such as osteoarthritis [51], chronic renal failure [52], gout [53] and rheumatoid arthritis [54]. Changes to the foot in addition to increased prevalence of chronic medical conditions with age [2,55] are the likely cause of high rates of non-diabetes related foot disease in this population. ...
Article
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Background: Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults. Aims: To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks. Methods: Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA. Results: Fifty-two patients (median age [inter-quartile range] 86.4 [79.2-90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a 'high risk' or 'at risk' foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 'at risk' and 2 'low risk' for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7-32.1] vs 15.2 [8-22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0-3] vs 0 [0-2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001). Conclusion: Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.
... Slippers often lack many key features that secure the shoe to the foot and reduce trips and slips. Poor fit (too long or too wide) have been noted as common in rehabilitation settings [8] and retirement villages [9] with older people, primarily for comfort and to accommodate foot deformities. Many slippers do not contain dorsal fixtures or have any form of stabilisation around the heel or sole area. ...
... prevent the foot from slipping and may reduce the risk of falls [8][9][10]. It has not been previously reported in the literature if the fit of the slipper is a contributing factor to falls and how this may compare to dorsally secured footwear. ...
Article
Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls.
... Appropriate fit of the footwear is an important factor in preventing foot disorders in the older people (Burns et al., 2002;Schwarzkopf et al., 2011). This cross-sectional observational study evaluated the shoe and foot mismatch and footwear style characteristics of the senior citizens in Tehran city. ...
... Our results about misfit footwear is consistent with other similar studies' results, showing that selecting an appropriate shoe size is not as easy as expected. Schwarzkopf et al. (2011), Menz and Morris (2005) and Burns et al. (2002) reported on ill-fitting shoes in the older population. This shoesize mismatch might be because of not measuring foot dimensions correctly when buying shoes. ...
Article
Full-text available
Appropriate shoe fit is an important factor for preventing foot disorders in older adults. This cross-sectional, observational study evaluated the shoe and foot mismatch of the older people and their footwear characteristics in Tehran city. Eighty senior citizens (50 women and 30 men) participated in this study. Their age range was from 65 to 87 years old. Fifty-seven of them (71.3%) were wearing shoes with improper lengths and 23.7% of them wore shoes with shorter lengths. All of the shoes and feet measurements differences were significant (length difference = −0.4 ± 0.7 (p = 0.000), metatarsophalangeal (MP) width difference = 1.2 ± 0.8 (p = 0.000), MP perimeter difference = 1.6 ± 0.8 (p = 0.000), heel width = 0.3 ± 0.7 (p = 0.000)). In more than 90% of the participants, the shoe’s width and MP region perimeter were shorter than the feet. We found weak but significant relationships between narrower MP and heel widths and hallux valgus (r = 0.33, p = 0.003 and r = 0.29, p = 0.009, respectively). Our results show that most of the participants wear poor-fitting shoes. It seems that many older adults have poor footwear with characteristics like non-supportive heel counter and no fixation.
... One of these measures may include wearing appropriate footwear. 7,8 Unfortunately, little current data or research focuses on the role of footwear in the prevention of inactivity in the elderly patients. ...
... Elderly individuals with preexisting clinical conditions such as diabetes, neuropathies, and musculoskeletal disorders are at a higher risk of developing foot problems when compared to normal, healthy individuals. 7,11 Furthermore, factors such as exercise and living conditions contribute to the development of foot problems. 3,12 Finally, the uneven pressure provoked by illfitting footwear has been documented as a key factor that can cause, accelerate, or exacerbate foot-related conditions. ...
Article
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Foot pathologies are common in nearly 80% of all elderly patients, and studies have indicated inappropriate footwear as one of the major underlying cause. It has been postulated that ill-fitting shoe wear affects plantar pressure, thus exacerbating weak balance. Complications arising from foot pathologies, which include difficulty in maintaining balance, have increased the risk of falls that can result in fractures and other serious injuries. The link between footwear and the onset or progression of certain foot pathologies has emphasized the need to explore and promote preventative measures to combat the issue. Wider and higher toe boxed shoes, along with sneakers, are examples of footwear documented to evenly distribute plantar pressure, increase comfort, and facilitate appropriate balance and gait. Ultimately, the use of appropriate footwear can help to better stabilize the foot, thus reducing the risk of sustaining debilitating physical injuries known to drastically decrease the quality of life among the geriatric population.
... In reality, both tight and wide footwear choices increase the risk for foot injuries, as tight shoes compress the soft tissues between two surfaces, and loose shoes allow friction between the shoe and inner footwear (Harrison et al, 2007). Wearing tight or wide shoes is common practice among those with diabetes (Burns et al, 2002). The authors questioned whether the tight-fitting shoes caused foot ulcers, or whether the presence of ulcers spurred people to buy roomy footwear in an attempt to reduce the seriousness of the ulcers (Burns et al, 2002). ...
... Wearing tight or wide shoes is common practice among those with diabetes (Burns et al, 2002). The authors questioned whether the tight-fitting shoes caused foot ulcers, or whether the presence of ulcers spurred people to buy roomy footwear in an attempt to reduce the seriousness of the ulcers (Burns et al, 2002). However, poor peripheral sensation is the reason people with diabetes purchase shoes that are too tight, to obtain the sense of immediate comfort (Uccioli, 2006;Harrison et al, 2007). ...
... The causes of the presence of foot disorders include increased body mass, inappropriate footwear, lack of basic care, and overuse of the feet, which can have life-long consequences [2,4]. Burns (2002) demonstrated that older people admitted to a rehabilitation unit (72%) generally used ill-fitting footwear [23]. This agrees with our data, which show a high prevalence of footwear with inadequate characteristics in the group of institutionalized patients. ...
... The causes of the presence of foot disorders include increased body mass, inappropriate footwear, lack of basic care, and overuse of the feet, which can have life-long consequences [2,4]. Burns (2002) demonstrated that older people admitted to a rehabilitation unit (72%) generally used ill-fitting footwear [23]. This agrees with our data, which show a high prevalence of footwear with inadequate characteristics in the group of institutionalized patients. ...
Article
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Few studies have focused on the relation between the use and characteristics of footwear and the presence of foot lesions in people with psychiatric disorders. This work analyzes the influence of different footwear habits on the presence of deformities and ungueal and dermal pathologies of the foot of institutionalized people with psychiatric disorders compared to people without these disorders. A transversal and observational study was conducted on 107 participants, divided into two groups who have used different types of shoes throughout their lives. The control group comprised 63 autonomous people who mainly use leather footwear and a study group of 44 institutionalized people with intellectual disabilities and psychiatric disorders who mainly use textile footwear. There were significant differences between populations. The group with psychiatric disorders presented more xerosis and hyperkeratosis. Footwear with inappropriate characteristics is a possible causal agent of skin alterations. Wearing footwear with quality textile uppers, e.g., fabric or felt, could influence the appearance of these alterations. Leather footwear is recommended for institutionalized people to reduce symptoms of xerosis and improve their quality of life.
... A previous study on shoe selection has reported that the use of incorrectly sized shoes significantly correlates with pain and ulceration [27]. Another study that is based on data from 227 women has reported that 48.5% were wearing incorrectly sized shoes, of which 12.8% were wearing shoes that were at least 1 cm larger than their feet [23]. ...
... Another study that is based on data from 227 women has reported that 48.5% were wearing incorrectly sized shoes, of which 12.8% were wearing shoes that were at least 1 cm larger than their feet [23]. A study that examined 65 older adults verified that 72% participants were, in fact, wearing incorrectly sized shoes (65% were wearing shoes larger than their feet) [27]. On the contrary, a study evaluating 356 women (age 20-60 years) has reported that 88% of patients were wearing shoes that were narrower than their feet [22]. ...
Article
Full-text available
Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.
... Particularly within older adults who often wear a shoe that is too narrow and long for the foot to improve comfort, which could have implications on associated pain [6]. This discrepancy between foot and shoe shape and sizing is often thought to lead to common foot pathologies [7,8]. Footwear advice in a clinical setting is often incorporated into effective treatment plans when ill-fitting shoes are linked to the presenting complaint, yet there is little understanding as to what specific advice should be given. ...
... Defining ill-fitting footwear is, particularly the appropriateness of fit, subjective and difficult to quantify, although there have been some attempts [11,12]. Ill-fitting footwear can be viewed as a shoe that is too big in length and width with a sloppy fit but could also be too short and cramped giving a tight fit [7,13,14]. However, ill-fitting could be extended beyond length and width to including shoes that impede normal function of the foot causing an altered gait pattern because of the shoe. ...
Article
Footwear has been used to protect feet for millennia with socially exclusive population adopting stylish and fashionable shoes with expensive materials. In terms of historic timeline, only more recently footwear has been worn by all classes in the western world as an integral part of their apparel. Traditionally, footwear has been constructed from natural materials, mainly leather, but has recently benefitted from the flexibility that technology has provided with a plethora materials and new design innovations. Although it has expanded the availability for a variety of consumers, the choice and fit continue to be problematic with many individuals wearing shoes that are ill-fitting. Provision of specific footwear advice for problem feet is poorly evidenced and is heavily practitioner dependant limiting its efficacy. There is limited understanding as to the changes that can occur from regularly wearing footwear that is unsuitable in shape, style and construction which is referred to as ill-fitting. Current research on the effect that everyday footwear has on foot function and pain focuses mainly on women's shoes, particularly high heels. Defining what is a good fitting shoe, that does not damage the foot or mechanics of walking, may need to be individualised, but best fit is based on loose historical parameters rather than research evidence. The aim of this overview is to highlight aspects of current research, establishing what is known about the effect's shoes have on the feet as well as exploring the mythology around footwear fit and advice that is often historical in nature.
... The fashion market has traditionally influenced the design of footwear and the prioritisation of style and footwear type, whilst potentially compromising the natural functioning of the foot (Coughlin & Thompson, 1995;McRitchie, Branthwaite, & Chockalingam, 2018;Menz, 2008). Footwear design is particularly important for older adults to reduce the risk of falls, and help maintain mobility, quality of life and independence (Burns, Leese, & McMurdo, 2002;Muchna et al., 2018;Palomo-López et al., 2017). With age, there is an increased risk of conditions such as diabetes mellitus which can lead to poor foot health (Burns et al., 2002). ...
... Footwear design is particularly important for older adults to reduce the risk of falls, and help maintain mobility, quality of life and independence (Burns, Leese, & McMurdo, 2002;Muchna et al., 2018;Palomo-López et al., 2017). With age, there is an increased risk of conditions such as diabetes mellitus which can lead to poor foot health (Burns et al., 2002). Gait (i.e. the pattern of how a person walks) can also change, with an impact on balance and increased risk of falls (Goehring, Bringer, Broders, & Young, 2018;Menant, Steele, Menz, Munro, & Lord, 2008a). ...
Article
With an ageing population there is a growing need for technology that enables older adults to live independently for longer. The EU Horizon2020 funded MATUROLIFE project is focused on developing solutions that embed smart textiles to support well-being and independence in older adults. The study described here aimed to explore and initiate development of ‘smart’ footwear embedding assistive technology. A qualitative research strategy was employed including interviews with 37 older adults and co-creation activities with 56 older adults. Participants were recruited from eight European countries (Belgium, France, Germany, Italy, Poland, Spain, Turkey, and United Kingdom). The results detail the specific needs that older adults have in relation to footwear based on the daily activities they take part in. Participants shared their footwear fashion preferences, as well as their priorities for assistive functionality. A set-of co-created priorities and concept ideas are presented that consider how footwear might enable independent ageing.
... Ill-fitting footwear can increase foot pain, reduce stability inhibit relevant rehabilitation and increase hyperkeratotic lesions [8,9]. Footwear characteristics such as heel height, toe box width, sole hardness and thickness have all been identified as elements that contribute to foot pain [10][11][12]. ...
... Correct fitting of shoes also plays a role in pathology and pain with two thirds of feet measuring broader than the footwear chosen. This appears to be more prevalent amongst women who wear longer shoes than necessary to accommodate width or depth changes [10,12,20]. ...
Article
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Background A high percentage of the population report footwear related foot pain, yet there is limited research on the effect footwear has on the development of this pain. The aim of this study was to establish whether footwear purchased by patients have an association with foot pain and what choices determined a purchase decision. Methods Shape and size measurements of the dominant foot and footwear (length and width) were taken from 67 female participants who routinely received podiatric treatment. Participants were also asked to complete a short questionnaire to rate the shoe characteristics, emotions whilst wearing and reasons for the purchase. Results Results highlighted a high prevalence of structural foot pathology for those over 61 who preferred slip on shoes. This group also wore shoes that were significantly narrower than their feet with width difference correlating to the presence of Hallux Abductovarus (HAV). In addition, results indicate that individual footwear advice is more important than previously thought, as it is clear that choice of footwear worn to podiatry appointments are not always worn on a daily basis. Conclusions This study emphasises that the width of the shoe is an important part of fit, highlighting the need for patient specific footwear assessment and education for behaviour changes.
... This is significant considering that the arch of the foot plays a vital role in balancing or walking. Although the effect of inappropriate footwear on the structure of foot has been extensively studied in other countries [28][29][30][31][32][33], limited research on the same has been available in Japan. ...
Article
Full-text available
Background: Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients. Methods: This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman's rank correlation tests. Results: Among the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status.Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale.For practice, both nurses and care workers had low mean scores for checking client's shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001). Conclusions: Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation.
... High-risk patients need to be advised about foot care, including correcting the shoe that may lead to ulceration [29]. Footwear trauma is a known cause of ulcers [30]. ...
Article
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Objective: To examine the clinical pattern of foot-related complications in type 2 diabetespatients. Material and methods: A cross-sectional study was conducted among indoor, adult type 2diabetes patients with risk factors for diabetic foot complications. The diabetic neuropathysymptom score (DNSS), Doppler scanning, ankle brachial pressure index (ABPI) assessment,neuropathy assessment, neuropathic disability score (NDS), biothesiometry evaluation, andbacteriological examination was performed. Diabetic foot risk stratification was done using theNICE risk stratification system. Foot ulcer severity was assessed with the Lipsky severitygrading system. Results: Ninety-one patients (mean age 59 years; male 65.9%) were included, of which 20 (22%)had a history of ulcer and 40 (44%) were smokers. Seventy-seven (83.5%) patients had aneuropathy symptom score between 4 and 9. Biothesiometry vibration perception threshold(VPT) was “severe” in 55 (60.4%) patients. Doppler assessment showed triphasic flow in 53patients (58.2%). Out of 52 patients (57.1%) with neuropathy, 30 (57.7%) had a severe problem.Diabetic foot ulcer, cellulitis, and callus were present in 44 (48.3%), 29 (31.5%), and 11 (12.4%)patients, respectively. Foot ulcers were present on 21 (38%) metatarsal heads, 11 (20%) toes, 10(18%) heels, 08 (15%) ankles, and 05 (09%) lateral foot borders. Of the 55 patients whounderwent culture examination, 30 (33.3%) showed the presence of Staphylococcus aureus. Asper NICE risk stratification, 55 patients (60%) were at “very high risk.” Conclusion: A foot ulcer is the commonest complication in diabetic patients followed bycellulitis. Standardized simple noninvasive testing methods should be used to identify patientsat risk for the diabetic foot. Multidisciplinary diabetic foot care could be useful to preventdiabetes-related amputation of the lower extremities.
... The width of the shoe was measured using a sliding caliper [34]. The caliper was placed over the upper part of the shoe, and the measurement was taken on the most medial and lateral parts of the shoe. ...
Article
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Background Research shows that ill-fitting shoes can negatively impact the development of the pediatric foot, in a very direct manner. The primary aim of the study was to determine if the dimensions of available prescribed school shoes fit the foot dimensions of habitually barefoot South African children and adolescents. Methods A cross-sectional observational study was conducted where static standing foot measurements of children and adolescents from urban and rural schools were obtained with a mobile caliper. The maximum heel-toe-length and foot width with an added 10 mm toe- and width fit allowance to each participant, were compared to the corresponding school shoe length and shoe width available in retail. A mixed model ANOVA was used to compare foot dimensions between gender, age and side. Results Six hundred and ninety-eight school children ( N = 698) (431 girls; 267 boys; average age 10.86 years, SD = 2.55) were participants. A total of seventy-seven ( N = 77) black coloured prescribed school shoes currently available in retail ranging from different styles and brands were measured. Results show that, comparing the shoe length and maximum heel-toe-length of participants, as well as taking 10 mm toe allowance into account, fifty-nine percent (59%) of children wore shoes that were not the correct length. With regards to the shoe width and the added 10 mm of width fit allowance, ninety-eight percent (98%) of the shoes worn by participants were too narrow for their feet. Conclusions Results confirmed that school shoes currently available in retail, are not suited for the habitually barefoot population studied. It is recommended that the shoe manufacturing industry should consider the shoe width of school shoes for children and adolescents in habitually barefoot populations to avoid the long-term negative effect of ill-fitting shoes on the pediatric foot.
... Many older adults (in some populations, the prevalence is three out of four) wear ill-fitted shoes. Burns et al 6 found 72% of older adults with chronic conditions (i.e., diabetes, peripheral vascular disease, sensory impairment) on a rehabilitation unit wore poorly fitted shoes, specifically in length. They found participants who reported wearing illfitted shoes with ulcerations also had a history of peripheral vascular disease. ...
A common debilitating condition in older adults which impact their level of independence involve conditions interfering with the ability to walk freely. Podiatric conditions develop over decades of wearing ill-fitted shoes, heels or as a result of chronic systemic conditions which impact the feet. This article will discuss the most common podiatric conditions frequently observed in older adults and steps that home health care providers should take to eliminate the threat of impaired mobility
... (J.M. Hijmans). [9,[12][13][14]. In the case of women, the use of high heels was an additional source of foot pain, even later in life [2]. ...
Article
Purpose: Describe age-related differences in women's foot shape using a wide range of measurements and ages. Study design: Cross-sectional, observational study. Main outcome measurements: Six foot-shape measurements of each foot: foot lengths, ball widths, ball circumferences, low instep circumferences, high instep circumferences, and heel instep circumference. Results: 168 women from 20 to over 80 years of age, divided into seven age categories, were included. Older women had significantly greater foot-shape measurements, even after adjusting for Body Mass Index. Ball widths increased 3.1-4.0mm per decade, ball circumferences 5.6-7.4mm per decade, high instep circumferences 0.4-4.8mm per decade, and heel instep circumferences 1.8-1.9mm per decade. Ball widths, ball circumferences, and left high instep circumference plateaued in the 70-75 years-of-age category, and decreased in the oldest age category. For low instep circumference, age did not prevail significantly over Body Mass Index. Foot length was not associated with age. Conclusion: This study described women's progressive foot-shape changes with age. The findings provide a better understanding of foot-shape changes, mainly found in the forefoot. It demonstrates that for a good fit, shoe design for older adults and for younger adults should differ.
... As any type of foot pain was included it is also possible that conditions associated with poor fit of enclosed shoes responded well to open style footwear and the reductions in pain were not related to function of the footwear but lack of pressure. Even if this is the case, the reduction in pain is still relevant as poor fitting shoes are a major contributor to foot pain in the community [44]. Further research would help to determine pathology explicit responses to this type of footwear. ...
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Background Foot pain is a common problem affecting up to 1 in 5 adults and is known to adversely affect activities of daily living and health related quality of life. Orthopaedic footwear interventions are used as a conservative treatment for foot pain, although adherence is known to be low, in part due to the perception of poor comfort and unattractiveness of the footwear. The objective of this trial was to assess the efficacy of flip-flop style footwear (Foot Bio-Tec©) with a moulded foot-bed in reducing foot pain compared to participant’s usual footwear. Methods Two-arm parallel randomised controlled trial using computer generated random allocation schedule at an Australian university podiatry clinic. 108 volunteers with disabling foot pain were enrolled after responding to an advertisement and eligibility screening. Participants were randomly allocated to receive footwear education and moulded flip-flop footwear to wear as much as they were comfortable with for the next 12 weeks (n = 54) or footwear education and instructions to wear their normal footwear for the next 12 weeks (n = 54). Primary outcome was the pain domain of the Foot Health Status Questionnaire (FHSQ). Secondary outcomes were the foot function and general foot health domains of the FHSQ, a visual analogue scale (VAS) for foot pain and perceived comfort of the intervention footwear. ResultsCompared to the control group, the moulded flip-flop group showed a significant improvement in the primary outcome measure of the FHSQ pain domain (adjusted mean difference 8.36 points, 95 % CI 5.58 to 13.27, p < 0.01). Statistical and clinically significant differences were observed for the secondary measure of foot pain assessed by a VAS and the FSHQ domains of foot function and general foot health. None of the participants reported any pain or discomfort from the intervention footwear and six (footwear group = 4) were lost to follow up. Conclusions Our results demonstrate that flip-flop footwear with a moulded foot-bed can have a significant effect on foot pain, function and foot health and might be a valuable adjunct therapy for people with foot pain. Trial registrationACTRN12614000933651. Retrospectively registered: 01/09/2014.
... Our results are in line with a previous report of Schwarzkopf et al, [32] indicating that proper footwear sizing is lacking among a large proportion of patients and this may be related to a higher number of foot injuries. [33][34][35] Also, the majority of elderly who took part in the survey pay little attention to their feet, only 12% (12 of 100) of the total of our participants performed foot health checks daily. Only 16.22% (6 of 37) from the group with neuropathy which suffer HL performed foot health checks daily, and the HL, as a risk factor for foot ulcer, might have been preventable. ...
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Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood. To discover footwear preferences of older people, pain tolerance may favor presence of HL for the use of inadequate footwear in old age. A sample of 100 participants with a mean age of 74.90 ± 7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants’ shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed. HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks.
... Pinzur et al. (2005) dealt, for example, with diabetics' foot care and shoes. Burns, Leese, and McMurdo (2002) studied the complications encountered by elderly people on a general rehabilitation ward wearing the wrong size of shoe. Jannink et al. (2006) effectively investigated the use of orthopaedic shoes by patients with degenerative disorders of the foot (i.e. ...
Article
Despite the growing interest in supply chain management (SCM), there is little literature on knowledge and competences needed to properly configure and manage a supply chain. There are some interesting methodologies to map the knowledge and the techniques used in the supply chain of a sector and transfer them in another sector. This is particularly important when cross-fertilisation of practices can support sectors facing global competition as the footwear industry. New business opportunities can in fact be exploited addressing the needs of specific target groups searching for customised fashion and healthy shoes. Based on literature review and case study analysis of twelve companies within the fashion and orthopaedic footwear supply networks, this work compares the relevant processes and the distinctive capabilities necessary in managing supply networks to implement customisation, identifying and highlighting the interchangeable best practices that could serve as a new common knowledge base to be shared by the two sectors.
... This is signi cant considering that the arch of the foot plays a vital role in balancing or walking. Although the effect of inappropriate footwear on the structure of foot has been extensively studied in other countries [27][28][29][30][31][32], limited research on the same has been available in Japan. ...
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Background: Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients. Methods: This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman’s rank correlation tests. Results: Among the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status. Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale. For practice, both nurses and care workers had low mean scores for checking client’s shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001). Conclusions: Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation.
... The width of the shoe was measured using a sliding caliper (34). The caliper was placed over the upper part of the shoe, and the measurement was taken on the most medial and lateral parts of the shoe. ...
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Background Research shows that ill-fitting shoes can negatively impact the development of the pediatric foot, in a very direct manner. The primary aim of the study was to determine if the dimensions of available prescribed school shoes fit the foot dimensions of habitually barefoot South African children and adolescents. Methods A cross-sectional observational study was conducted where static standing foot measurements of children and adolescents from urban and rural schools were obtained with a mobile caliper. The maximum heel-toe-length (HTL) and foot width (FW) with an added 10 mm (millimetres) toe and width fit allowance to each participant, were compared to the corresponding school shoe length and shoe width available in retail. A mixed model ANOVA was used to compare foot dimensions between gender, age and side. Results Six hundred and ninety-eight school children (N=698) (431 girls; 267 boys; average age 10.86 years, SD=2.55) were participants. A total of seventy-seven (N=77) black coloured prescribed school shoes currently available in retail ranging from different styles and brands were measured. Results show that, comparing the shoe length (SL) and HTL of participants, as well as taking a10 mm toe allowance into account, fifty-nine percent (59%) of children wore shoes that were not the correct length. With regards to the shoe width (SW) and the added 10 mm of width fit allowance, ninety-eight percent (98%) of the shoes worn by participants were too narrow for their feet. Conclusions Results confirmed that school shoes currently available in retail, are not suited for the habitually barefoot population studied. It is recommended that the shoe manufacturing industry should consider the shoe width of school shoes for children and adolescents in habitually barefoot populations to avoid the long-term negative effect of ill-fitting shoes on the pediatric foot.
... Whilst such contributions are hugely important, there has been a tendency for research to focus on older populations [2,21,22] or those with health conditions such as diabetes, gout or RA [17-19, 23, 24], and studies from a more sociological, qualitative perspective still remain comparatively rare. However, Branthwaite et al. [25] offer a fresh perspective in their research with teenage girls regarding their shoe purchases over 6 months. ...
Article
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Background This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development. Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and – crucially – any barriers to adopting ‘healthier’ footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. Conclusion A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary ‘moment’ of the clinical encounter.
... Furthermore, available evidence shows that foot structure development in children and teenagers may be effected by anatomical structures, different growth patterns and abnormal variation of plantar pressure [18][19][20]. Another factor that may greatly influence foot development relates to fashion designs [21,22]. For example, in the western countries footwear have proven not to be use only as functional materials, but represents personal identity and plays a vital role in the society [10]. ...
... We found a high number of older people to be wearing footwear larger than recommended on both feet. This is consistent with previous studies in older populations [30][31][32][33]. This may put these individuals at risk of trip-related falls [14]. ...
Article
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Background: Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods: A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants' self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann-Whitney U tests. Results: The mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions: Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.
... Our study discovered that more than 71.3% of diabetics wore poor grade footwear. In the United Kingdom it was observed that 72% (Burns et al., 2002) wore incorrect footwear size and 74% in the United States (Nixon et al., 2006) among the elderly group. In Thailand, 50% of women and 34% of women wore shoes that were too narrow (Chaiwanichsiri et al., 2008). ...
Article
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Background: Diabetic foot ulcer (DFU) is a preventable yet debilitating complication that is frequently seen in diabetic patients. Footwear has been implicated as contributing towards the development of foot ulcers and is the initial step leading towards lower limb amputations.
... In patients with hemiplegia, the loss of muscle strength and diminished sensation affects the ability to exercise postural control. Therefore, performing activities of daily living (ADL) tasks such as wearing shoes can be very difficult 1,2) . Some rehabilitation settings teach patients with hemiplegia to cross the paralyzed leg over the unaffected leg and then wear shoes. ...
Article
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[Purpose] Wearing shoes can be difficult for people who experience movement difficulties. This study aimed to compare young adults and senior adults while wearing shoes in order to quantify kinematic, physiological, and ergonomic points of variance. [Participants and Methods] Nine young adults (mean age, 21 years) and nine senior adults (mean age, 70 years) were included in the study. We investigated four postural combination of using hand and crossing legs used while wearing shoes: 1) time required to wear shoes, 2) the center of pressure point, 3) muscle activation within the right sartorius, the left rectus femoris, the gluteus maximus, and the internal oblique, and 4) the perceived ease of task performance via a numerical rating scale. [Results] The activities of the internal oblique and the gluteus maximus were significantly higher in senior adults than in young adults. Wearing shoes without using hands was associated with the highest value for the ease of performance among the four patterns for both groups. [Conclusion] Our results suggested that the muscles analyzed in this study were important for safety and postural maintenance while performing activities of daily living tasks in leg-raising processes in the sitting position, with lower level of muscle activity.
... This is significant considering that the arch of the foot plays a vital role in balancing or walking. Although the effect of inappropriate footwear on the structure of foot has been extensively studied in other countries [27][28][29][30][31][32], limited research on the same has been available in Japan. ...
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Background: Aging increases the likelihood for developing foot problems and reduces an individual’s ability for foot care. Hence, foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers in in-home service providers, along with their demographic characteristics and daily number of clients. Methods: This study analyzed 232 randomly selected front-line nurses and care workers across 35 in-home service providers in N City, A Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman’s rank correlation tests. Results: Among the 305 providers surveyed, 232 (76.1%; 63 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status. Significant differences in items related to early detection of foot problems (34.2%) and skin tears on lower limbs (25.5%) were observed between nurses and care workers. Both groups had low accuracy rates in the Shoes and Socks subscale. For practice, both nurses and care workers had low mean scores for checking client’s shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001). Conclusions: Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. Basic knowledge on early detection of foot problems and foot care, as well as other aspects, such as shoes and socks, dangers of sedentary behavior, and maintaining and improving clients’ foot health, is imperative.
... We found a high number of older people to be wearing footwear larger than recommended on both feet. This is consistent with previous studies in older populations [30][31][32][33]. This may put these individuals at risk of trip-related falls [14]. ...
Preprint
Full-text available
Background : Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods : A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants’ self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann–Whitney U tests. Results : The mean difference between shoe length and foot length was 18.6mm (SD: 9.6mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions : Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.
Article
Menschen stürzen im Alter aus verschiedenen Gründen. Einfluss nehmen zum Beispiel das Geschlecht, kognitive Fähigkeiten oder das Schuhwerk. In der Ergotherapie gilt es die Risikofaktoren für einen Sturz zu erfassen und herauszufinden, welche Interventionsmöglichkeiten in Frage kommen.
Article
Aim This paper determines whether patients with and without Diabetic Peripheral Neuropathy use suitable footwear, taking into account that these persons are subject to a significant loss of sensitivity in the feet. Methods Cross-sectional observational study was conducted of 108 participants with diabetes mellitus. Inclusion criteria were at least five years’ progression of diabetes, the ability to walk unaided and no distal amputation of the foot. The presence of DPN was evaluated according to the criteria of the International Working Group on the Diabetic Foot. Foot length was measured using a Brannock® device and internal shoe length was determined using a CEGI® pedometer. Results In relation to adjustment, 21.6% of the shoes examined had no type of closure. The most common form of closure was laces, which were used in 32.4% of the shoes. 92.5% of footwear had internal seams. No significant relationship was found between the presence or otherwise of DPN and the use of appropriate shoe closure (p = 0.304), recommended heel height (p = 0.18), leather material (p = 0.77) and absence of internal seams (p = 0.759). Conclusions The majority of our participants living with DPN do not wear fitting shoes. Therefore, it is advisable to evaluate their use of footwear, both in primary health care and in podiatry clinics, to forestall potential complications.
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Background: High-heeled shoes have been suggested as a main explanation for the female dominance in foot pain and deformities. Aim of study was to test this hypothesis scientifically. Methods: Women 40-66 years were included in two groups. 95 women who had worn high-heeled shoes at work for at least 5 years were compared to 102 women who had never worn high-heeled shoes at work. The investigations were weight bearing radiographs of foot and ankle, the SEFAS questionnaire and the AOFAS Clinical Rating System. Evaluators were blinded to the group-affiliation. Results: Radiographs showed no statistically significant differences between the two groups concerning deformities or joint disease. Foot function measured by SEFAS and AOFAS total score, were similar in the two groups. The high-heeled group had more pain and more callosities. Conclusion: For women aged 40-66 years wearing of high-heeled shoes had not caused foot deformation, but more foot pain and callosities.
Chapter
The human foot plays an important role in all weight-bearing tasks, as it provides the only direct source of contact between the body and the supporting surface. When walking, the foot contributes to shock absorption, adapts to irregular surfaces, and provides a rigid lever for forward propulsion (1). Any disruption to the precise timing of foot and ankle motion has the potential to decrease both the stability and efficiency of gait patterns.
Article
This chapter attempts to share with the readers, from a clinical point of view, the rationale of footwear design in relation to common foot problems. Each section focuses on one common foot problem with a brief explanation of the condition, followed by the key issues in footwear design.
Article
Orthotics involves the use of synthetic or mechanical devices in order to stabilize, heal, or prevent injury and deformity to weak joints or bones. The most common type of orthotic devices in use act to promote healthy feet. Foot problems such as corns, bunions, fallen arches, and heel pain are common in older people. In addition, conditions that increase in prevalence with advancing age often make footwear choice a problem, e.g. oedema secondary to heart failure. This article is not designed to be an in-depth review of all available orthotics, but a guide aimed at non-specialists to provide an overview of commonly-used devices. We describe the different types of shoes and adaptations available, as well as some foot and lower limb orthotics. We intend to outline the indications for the use of such devices as well as to highlight potential problems.
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This chapter has considered the nine domains within activity and participation, as conceptualised by the WHO (2001). It focuses on older peoples' 'doing' and 'being, discussing how both the ageing body and contextual factors can either facilitate or hamper occupational justice and successful ageing. Although this chapter has not instructed the reader in particular interventions, it is hoped that further tools and information are provided to support and enable clinical reasoning. It is also hoped that the chapter reveals different dimensions of an older person's experience so that their potential can be fulfilled in intervention.
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Introduction: The use of an improper shoe size is common in older people and is believed to have a detrimental effect on the quality of life related to foot health. The objective is to describe and compare, in a sample of participants, the impact of shoes that fit properly or improperly, as well as analyze the scores related to foot health and health overall. Method: A sample of 64 participants, with a mean age of 75.3±7.9 years, attended an outpatient center where self-report data was recorded, the measurements of the size of the feet and footwear were determined and the scores compared between the group that wears the correct size of shoes and another group of individuals who do not wear the correct size of shoes, using the Spanish version of the Foot Health Status Questionnaire. Results: The group wearing an improper shoe size showed poorer quality of life regarding overall health and specifically foot health. Differences between groups were evaluated using a t-test for independent samples resulting statistically significant (p<0.05) for the dimension of pain, function, footwear, overall foot health, and social function. Conclusion: Inadequate shoe size has a significant negative impact on quality of life related to foot health. The degree of negative impact seems to be associated with age, sex, and body mass index (BMI).
Chapter
Veel ouderen hebben voetklachten. Ze accepteren dit en zoeken geen hulp. De klachten beperken de loopafstand en verhogen de kans op vallen. Een goede schoen voor ouderen is dan ook belangrijk om drukplekken en ulcera te voorkomen, om de balanshandhaving positief te beïnvloeden en vallen te voorkomen. Veel ouderen kunnen prima met confectieschoeisel uit de voeten. Bij afwijkende voetstanden zijn vaak aanpassingen nodig of orthopedisch schoeisel. Bij voet- en loopproblemen moet naast anamnese en lichamelijk onderzoek ook een gangbeeldanalyse plaatsvinden. Een gangbeeldanalyse zonder anamnese en lichamelijk onderzoek is een kunstfout. Het is goed mogelijk om zonder geavanceerde apparatuur, maar met een eenvoudige camera veel belangrijke aspecten van het lopen te analyseren. In dit hoofdstuk worden de meest voorkomende aandoeningen en behandelmogelijkheden besproken. Schoenaanpassingen en vooral het dragen van orthopedisch schoeisel is voor veel mensen, en ook ouderen, vaak moeilijk te accepteren. Dit verdient dan ook veel aandacht.
Chapter
Das diabetische Fußsyndrom ist weltweit eine der bedeutendsten Komplikationen und häufigste Ursache für die Notwendigkeit einer Krankenhausbehandlung bei Patienten mit einem Diabetes mellitus. Die Ätiologie des diabetischen Fußsyndroms ist multifaktoriell und komplex. Die Pathophysiologie der diabetischen Fußläsion mit Polyneuropathie und Angiopathie sowie Wundheilungsstörungen aufgrund des Diabetes stehen hier im Vordergrund. Zur genaueren Beschreibung des diabetischen Fußsyndroms und zur Ableitung von Handlungsempfehlungen wurden unterschiedlichste Klassifikationen entwickelt. Gebräuchlich sind die Wagner- und die Armstrong-Klassifikation. Durch geeignete Behandlungsstrategien sowie interdisziplinäre und Sektoren übergreifende Strukturen ist es möglich, die vergleichsweise hohen Amputationsraten zu senken.
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Presentation and DiagnosisManagementPractice PointsFurther Reading
Chapter
Diabetes Mellitus (DM) has become one of the biggest healthcare challenges of the twenty-first century and it has become one of the major causes of morbidity and mortality across the world. According to the International Diabetic Federation, 425 million had diabetes in the year 2016 and by the year 2045, the number will escalate to 629 million [1]. One of the most common complications of diabetes is Diabetic Neuropathy. According to the American Diabetic Association diabetic neuropathy is “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes” ‘[2]. The prevalence of diabetic peripheral neuropathy ranges from 16% to 66% [3, 4]. While the incidence of amputation in diabetic patients is 10–20 times greater than in non-diabetic patients [5]. Diabetes Mellitus (DM) has become one of the major causes of morbidity and mortality across the world. Many factors were implicated in the development of Charcot foot such as soft tissue abnormality, abnormal mobility, diabetic peripheral neuropathy, abnormal plantar pressure, and altered gait pattern. A multitude of mechanisms for pathogenesis has been proposed like 1). lack of vaso-regulation resulting in a high flow state and opening of arteriovenous shunting due to underlying autonomic neuropathy, 2). Autonomic neuropathy contributes to local osteopenia by increasing the local blood flow, 3). Pain impairment in Charcot’s foot is associated with repeated injury, resulting in persistent proinflammatory conditions, contributing to chronic local osteolysis, 4). Binding of AGEs to their receptor (RAGE) prevents the differentiation of human mesenchymal stem cells. They induce apoptosis of osteoblast through the RANKL / NF-kβ pathway.
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Diabetic foot disease (DFD) or syndrome (DFS) is factors’ complex array in the macro-vascular (e.g., peripheral arterial disease) and microvascular (e.g., damage in the peripheral nerve) problems which affect diabetic patients and it is estimated one in three of diabetic patients will have the risk of DFD development as well as 10% of them will be developing DFU (Diabetic Foot Ulcer) in their lifetime [1, 2]. WHO defined DFS as “ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection” [3]. DFU is considered diabetes’ serious complication, which may lead to lower extremity amputation, which amounts amid 0.03–1.5% of patients with DFD [4, 5]. Compared to nondiabetic individuals, higher risk for major amputations that is nearly 30–40% has been found in type 2 diabetic patients [6]. Sensation loss due to diabetic peripheral neuropathy, ischemia caused by peripheral arterial diseases or their mixture may contribute to the development of foot ulcers in diabetic patients [7]. In another review, based on epidemiological data, it is estimated that 15% of the cases resulted in peripheral arterial occlusive disease (PAOD), only neuropathy is responsible for diabetic foot syndrome’s 50% cases approximately, whereas angiopathy and neuropathy combination results in the development of foot ulcerations which is nearly 35%. The diabetic foot is a distinctive example of diabetic neuropathy’s painless complication. The process of nociception-the pain perception developing from encoding’s neural processes as well as the noxious stimuli processing is worsening in the diabetic foot. Painless diabetic neuropathy is the underlying main cause for diabetic foot ulcers’ development, as it results in painless injuries and inflammation [8]. In addition to the above mentioned etiological factor for the diabetic foot ulcers development, the studies show a clear correlation among incorrectly fitted shoes and foot ulceration in older people with diabetes mellitus. In these studies, the patient with present ulceration, up to five times are likely not to wear correctly fitted shoes in comparison to patients that do not have any foot ulceration [9, 10]. The above evidence is cemented in a review by Andrew and Hylton, stating that the potential for the diabetic foot ulceration occurrence is greater in diabetic patients, who wear incorrectly fitting shoes than those without diabetes [11]. The objective of this chapter is to highlight the diabetic foot syndrome development risk factors, clinical features as well as recent progress in disease’s early detection.
Article
In this article, the author discusses the role of the podiatrist in sustaining and maintaining foot health. A number of core podiatry problems that are most commonly seen in the population are described, along with possible treatment options and when to refer to a podiatrist. The author also explains what is required to carry out a diabetic foot assessment, providing helpful links to resources and literature to aid practitioners' understanding of the processes involved, as well as providing a list of foot care tips to aid self-care.
Article
Menschen stürzen im Alter aus verschiedenen Gründen. Einfluss nehmen zum Beispiel das Geschlecht, kognitive Fähigkeiten oder das Schuhwerk. Für Therapierende gilt es die Risikofaktoren für einen Sturz zu erfassen und herauszufinden, welche Interventionsmöglichkeiten in Frage kommen.
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The purpose of this study was to investigate the prevalence and characteristics of foot problems in non-diabetic individuals compared with those in a diabetic population in order to develop recommendations for preventive foot care in older people. Retrospective review of a convenience sample of all patients referred to a Foot Care Service during a 24-month period. University Health Sciences Center. A total of 308 patients aged 33 to 95 years (176 women and 132 men), of whom 183 had diabetes mellitus (DM) and 125 were without DM. Each subject had a detailed history of foot care behavior and a thorough foot examination for peripheral neuropathy (PN), peripheral vascular disease (PVD), and foot deformities. PN was evaluated using the Semmes-Weinstein monofilament test. PVD was graded by clinical measures and Doppler examination (ankle:brachial index < 0.8). Forty-three percent of subjects with diabetes had PN, 32% had PVD, and 19% had both conditions. Eighteen percent of subjects without diabetes had PN, 21% had PVD, and 6% had both. The risk of foot abnormalities in those without DM increased with age (r = .99, P = .0002). Thirty-eight percent of non-diabetic patients older than age 60 had one or more of these major risk factors and would be considered at high risk for the development of foot ulcers or amputation. Ninety percent of the subjects reported inappropriate foot care practices. Forty-seven percent of non-diabetic individuals with PN or PVD wore inappropriate shoes. Older individuals without DM are at high risk for foot-related disease and should receive the same foot care screening, education, and follow-up as those with DM. Older people who have PN, PVD, or physical and psychosocial limitations, may require referral to foot care specialists.
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To conduct a prospective evaluation of footwear characteristics as predictors of diabetic foot wounds. A total of 352 patients with NIDDM enrolled in a randomized controlled trial aimed at preventing diabetic foot lesions in an academic general medicine practice were studied. Foot wounds (n = 63) were modeled univariately and multivariably using generalized estimating equations. The dependent variable was a wound classified as a 1.2 or greater according to the Seattle Wound Classification System, indicating at least a superficial or healing minor lesion with no functional interruption of the protective cutaneous barrier. Independent variables included detailed measures of style and material of patients' indoor and outdoor shoes, appropriate length and width, sock fibers, whether the patient had bought new shoes in the past 6 months, and if the patient had been recommended for special shoes. Modeling controlled for intervention status and physiological measures (baseline wound, monofilament abnormalities, and serum HDL level). Initial screening (P < 0.20) suggested that a recommendation for special shoes, shoe length, and shoe width were indicative of wounds at follow-up (odds ratios [ORs] 2.19, 1.84, 1.86, respectively), while having bought shoes in the past 6 months was associated with no wound at follow-up (OR 0.60). The final multivariable model included only the recommendation for special shoes (OR 2.19; 95% CI 1.07-4.49). Many variables commonly cited as protective measures in footwear for diabetic patients were not prospectively predictive when controlling for physiological risk factors. Rigorous analyses are needed to examine the many assumptions regarding footwear recommendations for diabetic patients.
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We have undertaken a prospective study of the presentation of all 669 ulcers seen in a specialist multidisciplinary foot clinic between 1 January 1993 and 1 August 1996, with particular reference to the factors which precipitated ulceration as well as to any delays in referral. Nearly two-thirds (61.3%) of all lesions were first detected by the patient or a relative, and the remainder by a healthcare professional. The median (range) time which elapsed between ulcer onset and first professional review was 4 (0-247) days, and the median time between first review and first referral to the specialist clinic was 15 (0-608) days. Significant delays were judged to have occurred in 39 instances. The most common precipitant of ulceration was rubbing from footwear, which was responsible for 138 (20.6%). Fifty-eight (8.7%) were the result of immobilization from other illness, and a further 24 were the consequence of surgery. Overall, professional factors contributed to the development or deterioration of 106 lesions (15.8% total). These results should form the basis of strategies designed to minimize the onset of ulceration in those known to be at risk: educational strategies need to be directed at professionals as much as at patients.
) was born at Angers, Maine-et-Loire, France, son of a tradesman He graduated in medicine in Paris with a gold medal
  • Rosper Ménière
rosper Ménière (1799–1862) was born at Angers, Maine-et-Loire, France, son of a tradesman. He graduated in medicine in Paris with a gold medal (1826), MD (1828), and became assistant to Dupuytren at the Hôtel Dieu; he eventually became chief physician to the Institution for Deaf Mutes.