Footwear fit as a causal factor in diabetes-related foot ulceration: A systematic review

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Petra J. Jones, David G. Armstrong, Robert Frykberg, Melanie Davies, Alex V. Rowlands
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Abstract

Aims

Incorrectly fitting footwear (IFF) poses a risk of trauma to at-risk feet with diabetes. The aim of this systematic review was to summarise and assess the evidence that IFF is a statistically significant cause of ulceration.

Methods

We searched PubMed, Scopus, Web of Science and Google Scholar for English-language peer-reviewed studies reporting the number or percentage of people with diabetes-related foot ulceration (DFU) attributed to wearing IFF and included a physical examination of the footwear worn. Two independent reviewers assessed the risk of bias using the Newcastle–Ottawa scale.

Results

4318 results were retrieved excluding duplicates with 45 studies shortlisted. Ten studies met the inclusion criteria with most rated as fair (n = 6) or good (n = 3). There is some evidence that DFU is significantly associated with IFF, but this is limited: only 3 of 10 included studies found a statistically significant percentage of those with DFU were wearing IFF or inappropriate footwear which included fastening, material, type or fit (15.0%–93.3%). Risk of bias in these three studies ranged from ‘fair’ to ‘poor’. IFF definitions were often unreported or heterogeneous. Only one study reported IFF-related ulcer sites: 70% were at plantar hallux/toes and 10% at plantar metatarsal heads.

Conclusions

There is some evidence that IFF is a cause of DFU, but further research is needed, which defines IFF, and methodically records footwear assessment, ulcer location and physical activity. Researchers need to uncover why IFF is worn and if this is due to economic factors, a need for footwear education or other reasons.

鞋的合脚性是糖尿病足溃疡的诱因之一:系统综述。
目的:不合适的鞋袜(IFF)会给糖尿病患者的高危足部带来创伤风险。本系统性综述旨在总结和评估有关 IFF 是导致溃疡的重要统计原因的证据:我们在 PubMed、Scopus、Web of Science 和 Google Scholar 上搜索了英语同行评议研究,这些研究报告了糖尿病足溃疡 (DFU) 患者的数量或百分比,这些溃疡归因于穿着 IFF,并包括对所穿鞋袜的物理检查。两位独立审稿人使用纽卡斯尔-渥太华量表评估了偏倚风险:除去重复的研究,共检索到 4318 项结果,其中 45 项研究入围。有 10 项研究符合纳入标准,其中大部分被评为一般(6 项)或良好(3 项)。有一些证据表明,DFU 与 IFF 有显著关联,但这种关联是有限的:在 10 项纳入的研究中,只有 3 项研究发现,在 DFU 患者中,穿着 IFF 或不合适鞋类(包括紧固、材料、类型或合脚度)的患者比例达到了统计学意义上的显著水平(15.0%-93.3%)。这三项研究的偏倚风险从 "一般 "到 "较差 "不等。IFF 的定义往往没有报告或不尽相同。只有一项研究报告了与IFF相关的溃疡部位:70%在足底/足趾,10%在足底跖骨头:有证据表明 IFF 是导致 DFU 的一个原因,但还需要进一步的研究来定义 IFF,并有条不紊地记录鞋类评估、溃疡位置和体力活动。研究人员需要揭示穿 IFF 的原因,以及这是否是由于经济因素、对鞋类教育的需求或其他原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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