Patient/caregiver were instructed on the contribution of poor fitting footwear for development and poor healing of diabetic foot ulcers as follows:
- Various mechanical forces acting on the feet of poorly managed diabetics, such as, shearing stress, friction, and compression due to the weight contribute significantly to risk for skin integrity.
- Coexisting neuropathy in these individuals can result in compromised nerve supply to the numerous small intrinsic muscles in the foot, which control the action of toes and maintain the shape & arches of the foot.
- Poor nerve supply to the intrinsic muscles of the foot leads to progressive atrophy of these muscles, resulting in stiffness & contractures of the toes, compromised arches of the foot, and altered gait patterns.
- Poor fitting footwear and altered shape of the foot due to neuropathy can lead to increased exposure of the foot to mechanical forces discussed above.
- Enhancement or worsening of effects of mechanical forces on the feet of poorly controlled diabetics contribute to increased risk for development of new pressure points and calluses on the foot. These new pressure points and calluses also carry potential to progress in future towards development of new diabetic foot ulcers.
- Altered pressure dynamics on the feet of poorly controlled diabetics contribute to worsening of existing foot ulcers, if any, resulting in poor healing. Compromised pain sensitivity in the extremities of poorly controlled diabetics allows these individuals to continue ambulating around on an ulcerated area of the foot, thus exposing the site to increased risk for infection and poor healing.
