Critical review. Part 1. Specialist footwear as a therapeutic intervention for diabetic foot problems – a critical review

Background Specialist therapeutic footwear is frequently recommended by clinicians and provided for patients with high-risk foot pathology associated with diabetes with the aims of preventing occurrence or reoccurrence of foot ulceration, reducing pressure-related symptoms such as pain and increasing mobility. However, current evidence is still inconclusive as to which footwear achieves the maximum health benefit for the clinical and patient focussed needs of this patient group. The aim of this review is to identify and evaluate the current evidence base of the effectiveness of therapeutic footwear in the management of the foot at risk of ulceration or reulceration. Method A search of the literature publlished between 1986 and 2006 was carried out. Those studies that fulfilled the inclusion criteria were critically appraised and graded using a pre-identified classification grading system. Results Six studies investigated the effectiveness of therapeutic footwear in preventing reulceration in the diabetic foot. A further three studies included footwear as part of the multifactoral management in preventing reulceration in the diabetic foot. Conclusions Although therapeutic footwear is often provided for patients with diabetes, particularly after one episode of foot ulceration, there is limited, good-quality evidence for its therapeutic effect with regard to clinical outcomes. Despite this, footwear does appear to make an important contribution in the management of foot problems in this patient group, particularly when combined with other foot-related interventions and when provided in a setting that facilitates patient choice, monitoring of the function of the footwear and patient engagement with its use. The complexity of providing footwear as a therapeutic intervention is evident, and the reviewer makes recommendations for both clinical practice and the focus and quality of future research