DIABETIC-PATIENTS COMPLIANCE WITH BESPOKE FOOTWEAR AFTER HEALING OF NEUROPATHIC FOOT ULCERS

Objectives : To define personal attributes and factors associated with compliance to wearing protective footwear in severely neuropathic dia betic patients with a history of foot ulceration. Design: Case-control study. Setting : Diabetic foot clinic. Subjects : 85 patients regular ly attenting the foot clinic were assessed after healing of neuropathi c foot ulceration. Intervention : Recommendation of wearing cushioned bespoke shoes instead of normal shoes, prescription of up to 2 pairs o f bespoke shoes on request. Main outcome measures : Clinical character istics and attitudes of compliant patients wearing bespoke shoes (case s) Versus non-compliant control patients wearing norma shoes on a rand om day. Results : The 51 case patients were significantly older and mo re often amputated than the 34 controls; they more frequently rated th eir feets' sickness and their overall health status as less favourable than did controls (p < 0.05). The controls, however, wer more often o n renal replacement therapy. Although the appearance of bespoke shoes was disliked by all of the patients, and 47 % of the cases and 100 % o f the controls would favour normal shoes for cosmetic reasons, all cas e patients wore their bespoke shoes according to the physicians recomm endation, as compared to 26 % of the controls (p < 0,01). Conclusion : Differences in age, perception of foot abnormalities and health statu s, and other distressing medical conditions (i.e. renal replacement th erapy, previous minor amputations) in addition to cosmetic reasons may affect the patients' compliance with bespoke protective footwear.