Australian guidelines on footwear for people with diabetes have been updated and released by the Australian Diabetes Foot Network.

The advice updates earlier guidelines released in 2013, and is based on new data from more recent trials and reviews, according to the Network.

Changes include new recommendations on footwear provision, education and adherence, cultural and geographical differences, they note.

The guidelines state that;

All people with diabetes at-risk of foot ulceration are advised:

•  to wear footwear that fits, protects and accommodates the shape of their feet.
•  to always wear socks within their footwear, in order to reduce shear and friction.
•  on the importance of wearing appropriate footwear to prevent foot ulceration.

For people at intermediate- or high-risk of foot ulceration are advised:

•  to obtain footwear from an appropriately trained professional to ensure it fits & protects.
•  to wear footwear at all times, both indoors and outdoors
• to check footwear, each time before wearing, to ensure that there are no foreign objects in the footwear, or penetrating, the soles.
• to check feet, each time footwear is removed, to ensure that there are no signs of abnormal pressure, trauma or ulceration
• People with a foot deformity or pre-ulcerative lesion, are advised to consider medical grade footwear, which may include custom-made in-shoe orthoses or insoles
• People with a healed plantar foot ulcer, are advised to consider medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure reducing effect at the high-risk areas
•  Prescribed footwear should be reviewed every three months to ensure it still fits, protects, and supports the foot

For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers

“We hope that this guideline will be used to ensure that all Australians with diabetes have access to, and are provided with, appropriate footwear to meet their needs,” the developers say.

“This should improve footwear practice in Australia, and reduce the burden of diabetic foot disease for people and the nation.”

The full list of recommendations and the rationale for them can be found in the Journal of Foot and Ankle Research (2018) 11:2.