The new 2018 Australia guideline on footwear for people with diabetes has just been published in the Journal of Foot and Ankle Research. This new footwear guideline updates the 2013 Australian practical guideline on the provision of footwear for people with diabetes. You may be asking how different can this new 2018 guideline be? We are biased; but, we suggest there are a few very important differences.
Let’s start with the methodology of the new 2018 guideline. Firstly, the similarities with the 2013 guideline include: it was partially based on expert opinion by Australian diabetic foot experts; the 2013 guideline by the Australian Diabetic Foot Network and the 2018 by Diabetic Foot Australia and many of these experts helped author both guidelines.
Now the differences in the 2018 guideline include: it was also based on a comprehensive literature review; included several pivotal new randomized controlled trials that demonstrated that specific footwear interventions prevent diabetic foot ulcers; included recommendations from new international offloading guidelines recently published; and was also authored by the very world experts that authored these studies and guidelines. Those world experts that authored the 2018 guidelines included: Professors David Armstrong, Sicco Bus, Keith Harding, Hylton Menz, Klaus Postema and Jaap van Netten.
So what did the 2018 guideline recommend we hear you say? Well the 2018 guideline has 10 key recommendations, several have remained very similar to the 2013 guideline, including:
- Advise people with diabetes to wear footwear that fits, protects and accommodates their feet
- Advise people with diabetes to always wear socks within their footwear
- Educate people on the importance of wearing appropriate footwear to prevent foot ulceration
- Instruct people at-risk of foot ulceration to obtain footwear from a trained professional
- Motivate people at-risk of foot ulceration to wear footwear at all times, indoors and outdoors
- Motivate people at-risk of foot ulceration to check their:
a. footwear, each time, to ensure that their are no foreign objects
b. feet, each time, to ensure that there are no signs of pressure, trauma or ulceration
But, there are also several key recommendations that are partially or completely different, including:
- For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses
- For people with healed plantar foot ulcers, prescribe medical grade footwear with custom-made in-shoe orthoses with a demonstrated plantar pressure reducing effect at high pressure areas
- Review prescribed footwear every 3 months to ensure it still fits, protects, and supports the foot
- For people with an active plantar foot ulcer, footwear is specifically not recommended for treatment; prescribe appropriate offloading devices instead to heal these ulcers
Other differences you’ll notice in the 2018 guideline include that it is set-out in a very similar way to the International Working Group on the Diabetic Foot guidelines structure, i.e.:
- The recommendations are clearly segmented into different foot risk status categories
- Each foot risk status category has several footwear recommendations
- Each recommendation is clearly stated for a particular patient sub-group(s) within the foot risk status group and is directly followed by the evidence-based rationale for each recommendation
- The discussion section outlines evidence-based considerations for optimal footwear provision, education, adherence, cultural differences, geographical differences and terminology
- There are several tables of easy-to-use definitions
- Lastly, and perhaps of most use, there are tables that guide clinicians on recommending specific footwear features shown to reduce plantar pressures on specific areas of the foot.
In conclusion, again we are biased, but in our opinion this new Australian guideline is the most up-to-date footwear guideline in the world. It has been written by the world’s experts to guide (inter)national clinicians prescribing footwear to patients with different diabetic foot risk status and complications. With this in mind, it is structured in a way to make it easy for clinicians to find the evidence-based information they need to recommend the right footwear for their patient sitting right in front of them.
So most importantly, we hope this guideline makes it easy for you to help your patients chose and wear the best evidenced footwear they can to prevent diabetic foot disease. And this then would be another very important step towards all of us ending avoidable amputations in a generation.
Learn more about the 2018 Australia guideline on footwear for people with diabetes when it’s officially launched at the ‘What’s New in DFU‘ event series in February. Early Bird Tickets are now on sale and strictly limited – so don’t miss this rare opportunity to participate in robust clinical discussion under the mentorship of Professor Keith Harding.