Toe gaps and their assessment in footwear for people with diabetes: a narrative review
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(2020) 13:70
REVIEW
Open Access
Toe gaps and their assessment in footwear for people with diabetes: a narrative review Petra Jones1,2* , Sicco A. Bus3, Melanie J. Davies1,2,4, Kamlesh Khunti1,2 and David Webb1,2
Abstract Background: Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal footwear length available to the foot. We summarised the literature on toe gaps in studies assessing footwear worn by people with diabetes, the methods used to measure both foot length and internal footwear length and identify ambiguities which may impact on toe gap assessment in clinical practice, and suggest pragmatic solutions. Methods: The Google Scholar database was searched to April 2020 for peer-reviewed studies using keywords related to incorrectly fitting or ill-fitting and diabetes, foot and ulcer which returned 979 results. Included studies within this narrative review encompassed toe gap measurement to assess footwear worn by people with diabetes. Results: A total of eight studies were included after full paper review. Toe gap ranges as used in assessments of footwear worn by people with diabetes vary, with a minimum of 1.0–1.6 cm and a maximum of 1.5–2.0 cm, as do methods of measuring internal footwear length. Only three published studies suggested possible measuring devices. Conclusions: Toe gap ranged as used when assessing footwear fit in people with diabetes vary and a gold standard device for internal footwear length measurement has yet to emerge. International guidelines provide welcome standardisation, but further research is needed to evaluate both the effect of toe gap ranges upon pressure, plantar stress response and ulceration and available measuring devices to facilitate development of toe gap measurement protocols that may further enhance consistency in practical assessments. Keywords: Diabetes, Foot, Ulcer, Fit, Footwear, Shoes, Measurement
Background The cost of diabetes-related foot ulceration comprises almost 1 % of the National Health Service’s usual annual budget costing up to £1.13 billion per year [1] with 90% of these costs associated with ulcer care rather than prevention [2]. Around 2% of people with diabetes in the UK are likely to develop a foot ulcer each year [3]. In the UK, 3.9 million people have a diagnosis of diabetes * Correspondence: [email protected] 1 Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK 2 Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK Full list of author information is available at the end of the article
[4] which suggests up to 78,000 people (2%) may potentially develop a foot ulcer each year. Lifetime prevalence of foot ulceration in people with diabetes may be as high as 30% [5]. Over three years of follow-up, risk of allcause mortality associated with foot ulceration can be 22% higher than in those with diabetes who do not devel
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