Loss of protective foot sensation and shoe wearing habits in persons with Diabetes Mellitus

Foot ulcers and lower extremity amputations are preventable complications of diabetes. It is reported that 50% of neuropathic diabetics have an event related to footwear that leads to amputation. One pathway to ulceration and amputation are foot injuries caused by shoes that are too small or inappropriate. The purpose of this study was to describe foot-wearing habits in people with diabetes. This descriptive study used a convenience sample of 60 adult men and women with a diagnosis of diabetes to describe diabetics foot-wearing habits. Demographic data were obtained through interview. Protective sensation was assessed using the Semmes-Weinstein monofilament. Feet were measured with a Brannock device and linear measures of length and width were obtained for each foot and shoe. Footwear appropriateness was measured with the_ Footwear Appropriateness Scale. Descriptive findings suggested that diabetics are poorly educated in foot care (n=30) and the selection of appropriate footwear (n=15). Descriptive findings suggested that the Semmes-Weinstein is an underutilized instrument to identify loss of protective sensation (n.=17). Paired t-test suggested that the group wore shoes that were too short (! =- 12.59, df=59, Q<.001 ), men wore shoes that were too short (!=-5.44, df=22, .Q<.001) and that women wore shoes that were too short (!=-14.565, df=36, .Q<.001) and too wide (-!=3.76, df=36, Q=.001 ). Chi-square suggested that diabetics perceived that they needed a smaller shoe that what they actually wore (X2 (182, N=60)=281.256, .Q<.001) and that the Brannock measured shoe size was larger than what they perceived that they needed (X2 (238, N=60)=366.808, .Q<.001 ). Mean scores indicate that diabetics wear adequate shoes (M = 10.33); men wear adequate shoes (M=11.3); women wear inadequate shoes (M=9. 73) and people with loss of protective sensation wear adequate shoes (M=10.37). These findings support observations that diabetics wear shoes that are too small. People with diabetes wear adequate shoes that may cause injury to their feet; women wear inappropriate shoes that are likely to cause injury to their feet. Implications for nursing include assessing risk with the Semmes-Weinstein, assessing footwear appropriateness, providing education related to foot care, shoe sizing and appropriate footwear to prevent shoe related injuries.