Custom-made footwear designed for indoor use increases short-term and long-term adherence in people with diabetes at high ulcer risk

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


Introduction To explore changes in footwear adherence following provision of custom-made indoor footwear in people with diabetes at high risk for plantar foot ulceration and in possession of regular custom-made footwear. Research design and methods Adherence indoors and outdoors was assessed objectively as percentage of steps custom-made footwear was worn, at baseline (in regular custom-made footwear), and at 1 and 12 months after providing custom-made indoor footwear (in both indoor and regular footwear). Primary group: participants with low (<80%) baseline indoor adherence; secondary group: participants with high (≥80%) baseline indoor adherence. Peak plantar pressures of the indoor footwear were compared with the regular custom-made footwear. Footwear usability was evaluated at 3 months via a questionnaire. At 12 months, ulcer recurrence was assessed through participant/prescriber reporting. Results Of 31 participants, 23 had low baseline indoor adherence (<80%). Overall adherence in this group increased statistically significant from median 65% (IQR: 56%-72%) at baseline to 77% (60%-89%) at 1 month (p=0.002) and 87% (60%-93%) at 12 months (p<0.001). This was due to a significant increase in adherence indoors: baseline: 48% (21%-63%); 1 month: 71% (50%-83%) (p=0.001); and 12 months: 77% (40%-91%) (p<0.001). Mean peak plantar pressures were comparable between the indoor and regular custom-made footwear. Participants were positive about usability. One-year ulcer recurrence rate was 26%. Conclusions Footwear adherence increased in the short-term and long-term after provision of custom-made indoor footwear in people at high risk of diabetic foot ulceration with low baseline adherence, because they actively wore their newly provided indoor footwear inside their house. Footwear adherence may be helped by using both regular and indoor custom-made footwear in clinical practice; the effect on ulcer recurrence should be investigated in future trials.

Original languageEnglish
Article numbere002593
JournalBMJ open diabetes research and care
Issue number1
Publication statusPublished - 7 Feb 2022


  • compliance
  • diabetic foot
  • foot ulcer

Cite this