The role of footwear in the prevention of diabetic foot problems

Abstract

While it is true that the foot represents the human interface with the ground, and that its anatomical structures, in particular its numerous joints, ligaments, and muscles are designed and optimized to receive and manage the outcomes of forces and torques due to the action of gravity on the entire human body, it is also true that, at least for civilized populations, footwear-alone or in conjunction with insoles-indeed represents the final interface with the ground. Shoes are thought, designed, and constructed to deal with a lot of factors, the most important of which should be the performance of a comfortable progression action while maintaining as much as possible the biomechanics of a physiological gait. Often, other factors like cost and fashion do interfere with the above aim and lead to solutions which are uncomfortable and, on a longer time scale, which represent the main cause for the onset of relevant and potentially dangerous changes in gait. This is especially true for diabetic patients with long-term complications, such as peripheral neuropathy, that deeply influence physiologic gait and make the patient vulnerable and at risk of foot ulceration. Unsuitable footwear may precipitate this condition and may be responsible for the appearance of a foot ulcer.