One Shoe Doesn't Fit All: A Contextual Approach to Therapeutic Footwear for People at Risk of Diabetes-Related Foot Ulceration

Introduction: People at risk of diabetes-related foot ulcers are recommended to always use therapeutic footwear when weight-bearing, to help prevent ulcers. These recommendations are supported by good quality evidence, yet adherence by patients to using this footwear is low. One reason may be because these recommendations do not consider that footwear use is highly contextual to the physical or sociocultural environments it is intended to be used. In this paper, we propose and discuss a contextual approach to considering therapeutic footwear solutions. Contextual Approach to Therapeutic Footwear: Recommending patients to use the same therapeutic footwear solution in vastly different contexts seems at odds with person-centred care principles and is likely a reason for patients not fully adhering to such recommendations. We discuss seven contexts in which using therapeutic footwear is particularly challenging: the home, workplaces, social occasions, places-of-worship, water-related activities, hotter climates and holidays. We outline how a contextual approach to therapeutic footwear might lead to more appropriate footwear solutions. This approach typically involves a trade-off between functional benefits and adherence and may lead to novel designs for different contexts. We also propose six different footwear solutions that incorporate features that may be more aesthetically pleasing, cooler, lighter, cheaper or waterproof, yet still providing protection and functional offloading. We suggest outcomes of such an approach may be more favourable for the patient's overall adherence and foot health than the current somewhat unrealistic recommended practice of prescribing a “one shoe fits all” solution. Conclusion: A contextual approach as proposed in this paper may lead to novel therapeutic footwear solutions that better address patients' needs for adequate footwear. If these footwear solutions are implemented, this may in future lead to higher patient adherence to using appropriate footwear and lower ulceration rates.