Users’ needs and expectations and the design of a new custom-made indoor footwear solution for people with diabetes at risk of foot ulceration

Abstract

Purpose

To assess users’ needs and expectations regarding custom-made indoor footwear, and to design such footwear with similar biomechanical efficacy and better usability compared to regular custom-made footwear in people with diabetes at risk for foot ulceration.

Materials and methods

Multidisciplinary systematic design approach. Needs and expectations regarding indoor footwear were evaluated via a questionnaire in 50 high foot ulcer risk people with diabetes using custom-made footwear. We systematically designed indoor footwear, and manufactured this for nine participants. Primary requirement was similar plantar pressure compared to participants’ regular custom-made footwear.

Results

Eighty-two percent of participants expressed a need for custom-made indoor footwear and 66% expected such footwear to increase their adherence. The custom-made indoor footwear had the same bottom construction as participants’ regular custom-made footwear, but with softer and more light-weight upper materials. Peak pressures were similar or lower, while qualitative evaluation showed better usability and lower costs for indoor footwear.

Conclusions

People with diabetes at risk of foot ulceration expressed a clear need for custom-made indoor footwear, and expected such footwear to increase their adherence. Our indoor footwear design provides adequate pressure relief, with better usability, and can be produced at lower costs compared to regular custom-made footwear.

Implications for rehabilitation

• People with diabetes at risk of foot ulceration express a need for special indoor footwear.

• We developed indoor footwear with similar offloading capacity as regular custom-made footwear.

• The indoor footwear is lighter in weight, easier to don/doff and lower in costs.

• At-risk people with diabetes expect this footwear to increase their footwear adherence.

Keywords:

• Diabetes mellitus
• foot ulcer
• prevention
• footwear
• adherence

Acknowledgements

We would like to thank the orthopedic footwear companies, their pedorthists and their management representatives for their time and energy dedicated to the project: Livit Orthopedie (Jan Pulles, Carlijn Renee, Esther Mik), Buchrnhornen BV (Frans Buchrnhornen, Bart van Heerebeek) and OIM Orthopedie (Sjakko Lieben, Yvette Kerkum, Cock Vergeer). We would also like to thank Diabetes Vereniging Nederland (Diabetes Association Netherlands) (Dayline Coffie, Olof King) and CZ Zorgverzekering (CZ Health Insurance) (Marjan Peelen, Tanja Bastiaansen, Dion van Bommel) for their participation in the project group, and MyOrthopedics (Vincent Bergmans) for providing all details on the materials of the indoor footwear.

Disclosure statement

The authors report no conflicts of interest. The companies who participated in the research manufactured the custom-made indoor footwear according to the design described in this paper. However, there is no protected intellectual property to any of the ideas presented, there are no ideas or outcomes withheld from publication because of commercial interest, and none of the companies or researchers has any protected financial interests in relation to the design presented.

Data availability statement

Data can be made available upon reasonable request.

Additional information

Funding

This study was supported by an unrestricted grant from CZ Fonds.