A study on non-healing plantar diabetic foot ulcers to assess the effect of compliance of using customised footwear in wound healing


  • Pallela Narayana Someshwara Rao Department of General Surgery, Sri Muthukumaran Medical College and Hospital, Mangadu, Chennai, India
  • Anil Vince Vincent Department of Medical and Surgery, Jainee College of Nursing, Dindigul, Tamil Nadu, India




Customised footwear, Compliance, Diabetic foot plantar ulcers


Background: Foot infection is one of the commonest reasons for hospital admission of individuals with diabetes in India. Prescription footwear is an intricate aspect of a treatment program, not a therapy unto itself. Custom-made footwear can only be effective in preventing diabetic foot ulcers if worn by the patient as advised. This study was done in patients who are already prescribed customised footwear and evaluated the need for compliance based on the healing of these plantar foot ulcers.

Methods: 85 diabetic patients with severe neuropathy and a non-healing callus ulcer or trophic ulcer (diameter 1-3 cm) for more than 3 months were included in the study. All these patients were followed up on weekly basis for 3 months and questioned about the use of customized footwear on regular basis. At the end of three months, the healing of these foot ulcers was compared based on whether they had been compliant with the customized footwear advice.

Results: Of the 85 patients, 25 (29.4%) had shown improvement in wound healing with regular use of footwear. 60 (70.5%) patients who were not using the customized footwear had not shown any improvement in the plantar ulcers. The reasons for not using the recommended footwear were many commonest being wearing footwear only when going out and not inside the home.

Conclusions: Non-compliance with customised footwear is emerging as an important cause of delay in wound healing of plantar foot ulcers.

Author Biography

Pallela Narayana Someshwara Rao, Department of General Surgery, Sri Muthukumaran Medical College and Hospital, Mangadu, Chennai, India

General Surgery , Associate Professor


Centers for disease control and prevention. diabetes: a serious public health problem. At a glance 2000. Washington, DC: US Department of Health and Human Services; 2000.

Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris MI, Cowie C, Stern MP, editors. Diabetes in America. 2nd edition. Bethesda (MD): National Institutes of Health; 1995:409-428.

Centers for disease control and prevention. diabetes surveillance, 1999. US Department of Health and Human Services. Available at: http:// www. cdc.gov/diabetes/statistics/surv199/ chap6/

chapter6Intro.htm. Accessed on 10 March 2003.

Pecoraro RE, Reiber G, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diab Care. 1990;13:513-21.

Adler AI, Boyko EJ, Ahroni J, Smith DG. Lower-extremity amputation in diabetes: the independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diab Care. 1999;22:1029-35.

Apelquist J, Larsson J, Agardh CD. Long term prognosis for patients with foot ulcers. J Int Med. 1993;233:485-91.

Reiber GE, Vileikyte L, Boyko EJ. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diab Care. 1999;22:157-62.

Abbott CA, Vileikyte L, Williamson S. Multicenter study of the incidence and predictive risk factors for diabetic neuropathic foot ulceration. Diab Care. 1998;21:1071-5.

Boyko EJ, Ahroni JH, Stensel V. A prospective study of risk factors for diabetic foot ulcer: the Seattle Diabetic Foot Study. Diab Care. 1999;22:1036-42.

Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician. 2002;66:1655-62.

Abbott CA, Carrington AL, Ashe H. The North-West diabetes foot care study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabetic Med. 2002;19:377-84.

Frykberg RG, Armstrong DG, Giurini J. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. 2000;39(1):2-60.

Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician. 2002;66:1655-62.

Catanzariti AR, Haverstock BD, Grossman JP, Mendocino RW. Off-loading techniques in the treatment of diabetic plantar neuropathic foot ulceration. Adv Wound Care. 1999;12:452-8.

Lavery LA, Vela SA, Lavery DC, Quebedeaux TL. Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. Diab Care. 1996;19:818-21.

Arts ML, Haart M, Bus SA. Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration. J Rehabil Med. 2014;46(4):357-62.

Paton JS, Roberts A, Bruce GK, Marsden J. Patients’ experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: an interpretative phenomenological analysis (IPA). J Foot Ankle Res. 2014;7(1):16.

Bakker K, Apelqvist J, Schaper NC, International Working Group on Diabetic Foot Editorial Board. Practical guidelines on the management and prevention of the diabetic foot 2011. Diab Metab Res Rev. 2012;28(1):225-31.






Original Research Articles