Effect of recommended footwear fit upon in‐shoe pressures in feet with diabetes—An exploratory study

AIMS: Diabetes-related foot ulceration (DFU) can be caused by incorrectly fitting footwear, yet there is a lack of consensus around recommended toe gaps within footwear. We assessed mean in-shoe peak plantar pressures associated with alternative toe gap ranges during walking within standardised footwear at a standard pace. Secondary aims included assessing footwear fit and in-shoe pressures in habitual footwear. METHODS: People with diabetes wore standardised footwear with three toe gap ranges: 0.5-1.0 cm, 1.0-1.5 cm and 1.5-2.0 cm. In-shoe peak plantar pressures were measured during walking at 1 m/s ± 5%. Twenty-five participants were recruited, with data available for 17 participants given footwear tolerance and equipment issues. RESULTS: Mean right hallux in-shoe peak plantar pressures were higher in 1.5-2.0 cm toe gaps (236.3 ± 23.5 kilopascals) than in 0.5-1.0 cm toe gaps (142.2 ± 20.5 kPa, p = 0.03) based on linear regression single covariate analysis. More three-quarters of participants wore habitual footwear of incorrect length and almost half wore incorrect width. CONCLUSIONS: This exploratory study suggests that larger toe gaps may be associated with increased hallux plantar pressures, in some cases exceeding 200 kPa-a commonly cited threshold associated with increased DFU risk. These findings should be confirmed in larger, adequately powered studies.