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A recent study found that 25.5 percent of veterans at one VA facility wear correctly sized shoes. Researchers says patients with a diabetic foot ulcer are 5.1 times more likely to be wearing incorrectly sized shoes than those without ulceration. (Photo co
Here one can see a moderate diabetic foot infection. A recent study concludes that higher baseline diabetic wound scores correspond to lower clinical response rates. (Photo courtesy of Warren Joseph, DPM)
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By Brian McCurdy, Senior Editor

Study: Wrong Shoe Size In Veterans Tied To Diabetic Ulcers

     Shoes that fit poorly are often named as a factor in the development of diabetic foot ulcers. A recent study in the Journal of the American Podiatric Medical Association (JAPMA) questioned whether veterans wear appropriately sized shoes and found that three-quarters of those studied did not.

     Study authors evaluated the shoe sizes of 440 veterans at Southern Arizona Veterans Affairs (VA) Medical Center. Of those, 58.4 percent had diabetes and 6.8 percent had an active diabetic foot ulcer. Researchers found only 25.5 percent were wearing shoes in an appropriate size. Inappropriately sized shoes were defined as shoes that were at least one full size too small or too large, notes the study.

     Those with a diabetic foot ulcer were 5.1 times more likely to have ill-fitting shoes than those without an ulcer, according to the study. To help prevent ulceration, authors advocate “meticulous” screening for discrepancies between the foot and shoe size.

     Several podiatrists who have experience with treating veterans have had similar experiences with inappropriate shoe size.

      “Most of my patients, veteran or non-veteran, do not wear the appropriate shoe size,” says study co-author David G. Armstrong, DPM, PhD, a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine in Chicago.

     Dr. Armstrong adds that other studies have suggested that three-fourths of people wear inappropriately sized shoes. At Edward Hines Jr. VA Hospital, the staff estimates nearly half of its veterans wear shoes that do not fit, according to Ronald Sage, DPM, a Staff Podiatrist at the Hines VA. Mark Caselli, DPM, has encountered a “very high incidence” of veterans wearing shoes that are too small. He says this is common among vets in their 70s and 80s, with diabetes and without.

Understanding The Reasons Why People Wear Ill-Fitting Shoes

     Why do some veterans not wear proper footwear? Dr. Caselli, a staff podiatrist at the VA Hudson Valley Health Care System in Montrose, N.Y., says ill-fitting shoes may be due to the “frugal nature” of the patients, who may try to get the most out of a pair of old shoes.

     Along the same lines, Dr. Sage cites economic reasons, saying many VA patients simply cannot afford properly fitted quality shoes. However, he says in the VA system, DPMs can obtain therapeutic shoes for most high risk diabetic or dysvascular patients.

     Neuropathy may be another cause of ill-fitting shoes as patients may be unable to feel if their shoes are too tight, according to Dr. Caselli. In general, Dr. Caselli has found that “ … most of the diabetic ulcers on the dorsum of the foot, especially toes and the sides of the foot, were due to shoes that are too small. Ulcers on the plantar aspect of the foot are not often related to improper shoe size but tend to be due more to a lack of shock absorption.”

     Dr. Caselli says another factor is that the foot becomes larger and wider as people age, and also gets bigger due to edema. He notes that patients tend to remember their shoe size, even if the foot was measured 30 years ago, and believe they should always get that same size shoe.

      “People have to get out of the habit of feeling that their shoe size is like a Social Security number. Sizes can be different and can change,” notes Dr. Armstrong, a former Director of Research and Education within the Department of Surgery, Podiatry Section at the Southern Arizona Veterans Affairs Medical Center.

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