Design Specifications of Proper Footwear to Prevent Diabetic Complications and Enhance Ergonomic Comfort

Document Type : Original Article

Authors

1 Faculty of Applied Arts, Helwan University, Orman Giza

2 Emeritus professor, Founder and former head of the Leather Industries Department, Faculty of Home Economics, Helwan University,

3 Professor of Vascular Surgery, Department of Vascular Surgery, Faculty of Medicine (Kasr Al Ainy), Cairo University

4 Head & chief diabetologist, Center of Excellence in Diabetes care, International Diabetis Fedration

5 PhD Candidate, Leather Industries Department, Faculty of Home Economics, Helwan University

Abstract

Foot-related complications are common among people with diabetes and are important causes of hospitalization and amputation. Recommendations for persons with diabetes include wearing suitable shoes to reduce foot complications, but such shoes are generally not readily available. This study aims to improve foot comfort and prevent foot complications by modifying conventional design requirements for shoes. Traditional requirements include lightweight construction, good plantar contact, anatomical last, and good side support. However, many commercial shoes deviate from these requirements, leading to interest among occupational therapists. The study focuses on well-structured shoes with ergonomic comfort, focusing on the design of the last and shock-absorbing element. It also suggests foot orthoses and shoe dimensions that approximate the natural plantar contour to prevent ulceration in diabetic neuropathic feet. The ultimate objective is to reduce healthcare costs for hospitals, factory workers, and mountaineers by providing proper footwear. The research aims to provide better autochthonous windy footwear and address the growing diabetic population's needs. Proper footwear is represented by a specific area in the footwear field, which has as its main objective providing biomechanical support in a comfortable way for the entire biological variation of the human foot. Findings: The study illustrated a precise quantitative grid of the scientific findings in the area of diabetes-related foot complications and also in the technological advancements for creating the proper shoe. It provided an updated footwear design specifications based on the feedback obtained from expert fitting specialists. Also, a set of updated standards for classifying the established specifications, checking their relevance to these stakeholders' competence and daily work activity has been designed. A convenient criteria from the study which might significantly influence a favorable position and unique function regarding the appropriate foot presentation concerning footwear ergonomics was concluded. 

Keywords

References

  1. Agresta, C., Giacomazzi, C., Harrast, M., & Zendler, J. (2022). Running injury paradigms and their influence on footwear design features and runner assessment methods: A focused review to advance evidence-based practice for running medicine clinicians. Frontiers in sports and active living, 4, 815675.  [Source]
  2. Alves Bernardes, R., Caldeira, S., Stolt, M., Santos-Costa, P., & Cruz, A. (2024). Rehabilitation strategies and footwear recommendations for nurses in standing environments: a narrative review. Revista Portuguesa de Enfermagem de Reabilitação, 7(1).  [Source]
  3. Asghar, A. & Naaz, S. (2022). The transverse arch in the human feet: A narrative review of its evolution, anatomy, biomechanics and clinical implications. Morphologie. [Source]
  4. Barbara, A. M., & Horton, J. (2022). Custom-Made Foot Orthotics for People With Lower Limb Conditions. Canadian Journal of Health Technologies, 2(2).  [Source]
  5. Behling, A. V., Manz, S., von Tscharner, V., & Nigg, B. M. (2020). Pronation or foot movement—What is important. Journal of Science and Medicine in Sport, 23(4), 366-371.  [Source]
  6. Bellomo, T. R., Lee, S., McCarthy, M., Tong, K. P. S., Ferreira, S. S., Cheung, T. P., & Rose-Sauld, S. (2022, June). Management of the diabetic foot. In Seminars in Vascular Surgery (Vol. 35, No. 2, pp. 219-227). WB Saunders. [Source]
  7. Blagorodov, A. A., Bordukh, D. O., Prokhorov, V. T., Volkova, G., & Tikhonova, N. V. (2020). Search for Effective Means to Reduce Pathological Abnormal Diseases of Children's Feet. Current scientific research in the modern world, (12-3), 18-74.[Source]
  8. Bodoga, A., Nistorac, A., Loghin, M. C., & Isopescu, D. N. (2024). Environmental Impact of Footwear Using Life Cycle Assessment—Case Study of Professional Footwear. Sustainability.  [Source]
  9. Castro-Martins, P., Pinto-Coelho, L., Vaz, M., Pinto, M., & Marques, A. (2023, May). Towards an In-Shoe Pneumatic Insole to Plantar Injury Prevention in Diabetic Foot. In Congress of the Portuguese Society of Biomechanics (pp. 311-319). Cham: Springer Nature Switzerland. [Source]
  10. Cha, Y. J. (2022). Effectiveness of Shock-Absorbing Insole for High-Heeled Shoes on Gait: Randomized Controlled Trials. Healthcare.  [Source]
  11. Chang, M. C., Choo, Y. J., Park, I. S., Park, M. W., & Kim, D. H. (2022). Orthotic approach to prevention and management of diabetic foot: A narrative review. World Journal of Diabetes, 13(11), 912.  [Source]
  12. Chatzistergos, P. E., Gatt, A., Formosa, C., Farrugia, K., & Chockalingam, N. (2020). Optimised cushioning in diabetic footwear can significantly enhance their capacity to reduce plantar pressure. Gait & Posture, 79, 244-250.  [Source]
  13. Chicharro-Luna, E., Ortega-Avila, A. B., Requena-Martínez, A., & Gijon-Nogueron, G. (2021). Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: a cross-sectional study. Primary Care Diabetes, 15(1), 145-149. [Source]
  14. Chicharro-Luna, E., Ortega-Avila, A. B., Requena-Martínez, A., & Gijon-Nogueron, G. (2021). Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: a cross-sectional study. Primary Care Diabetes, 15(1), 145-149. [Source]
  15. Collings, R., Freeman, J., Latour, J. M., & Paton, J. (2021). Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses. Endocrinology, diabetes & metabolism, 4(1), e00132.  [Source]
  16. Dewi, F. & Hinchliffe, R. J. (2020). Foot complications in patients with diabetes. Surgery (Oxford).  [Source]
  17. Edmonds, M., Manu, C., & Vas, P. (2021). The current burden of diabetic foot disease. Journal of clinical orthopaedics and trauma.  [Source]
  18. Ermakova, E. O., Kiselev, S. U., & Kostyleva, V. V. (2020, October). A concept of automated selection of orthopedic shoes. In The International Conference “Health and wellbeing in modern society”(ICHW 2020) (pp. 119-124). Atlantis Press.  [Source]
  19. Faerber, G., Fennema, P., Hirsch, T., Szuba, A., & Kahle, B. (2024). Benefits of an Adjustable Compression Garment System for the Reduction of Chronic Leg Oedema (ACROE Study). European Journal of Vascular and Endovascular Surgery. [Source]
  20. Ferreira, A. C. B. H., Ferreira, D. D., Oliveira, H. C., de Resende, I. C., Anjos, A., & de Moraes Lopes, M. H. B. (2020). Competitive neural layer-based method to identify people with high risk for diabetic foot. Computers in biology and medicine, 120, 103744.  [Source]
  21. Firtikiadis, L., Manavis, A., Kyratsis, P., & Efkolidis, N. (2024). Product Design Trends within the Footwear Industry: A Review. Designs.  [Source]
  22. Gorade, V. G., Chaudhary, B. U., & Kale, R. D. (2021). Moisture management of polypropylene non-woven fabric using microcrystalline cellulose through surface modification. Applied Surface Science Advances.  [Source]
  23. Haque, M. S., Enu, Y. A., Shahriar, M. M., & Jor, A. (2023). Foot complications and footwear habits: A study of diabetes mellitus patients in Bangladesh. Journal of Engineering Science, 14(1), 77-83.  [Source]
  24. Hatton, A. L., Chatfield, M. D., Gane, E. M., Maharaj, J. N., Cattagni, T., Burns, J., ... & Kerr, G. (2024). The effects of wearing textured versus smooth shoe insoles for 4-weeks in people with diabetic peripheral neuropathy: a randomised controlled trial. Disability and Rehabilitation, 1-11.  [Source]
  25. Hinton, Z. (2023). Enhanced Digital Capability through the use of Simulation in Footwear Product Creation.  [Source]
  26. Iraqi, A., Vidic, N. S., Redfern, M. S., & Beschorner, K. E. (2020). Prediction of coefficient of friction based on footwear outsole features. Applied ergonomics.  [Source]  
  27. Isherwood, J., Rimmer, E., Fu, F., Xie, Z., & Sterzing, T. (2021). Biomechanical and perceptual cushioning sensitivity based on mechanical running shoe properties. Footwear Science. [Source]
  28. Jais, S. (2023). Various types of wounds that diabetic patients can develop: a narrative review. Clinical Pathology.  [Source]
  29. Jhanji, Y. (2021). Sportswear: acumen of raw materials, designing, innovative and sustainable concepts. Textiles for functional applications. [Source]
  30. Jones, P., Bus, S. A., Davies, M. J., Khunti, K., & Webb, D. (2020). Toe gaps and their assessment in footwear for people with diabetes: a narrative review. Journal of Foot and Ankle Research, 13, 1-7.  [Source]
  31. Keukenkamp, R., van Netten, J. J., Busch-Westbroek, T. E., Nollet, F., & Bus, S. A. (2022). Users’ needs and expectations and the design of a new custom-made indoor footwear solution for people with diabetes at risk of foot ulceration. Disability and rehabilitation, 44(26), 8493-8500.  [Source]
  32. Kim, H. A. (2023). Eco-friendly fibers embedded yarn structure in high-performance fabrics to improve moisture absorption and drying properties. Polymers.  [Source]
  33. Lee, S. H., Lee, C., Yang, M. C., & Coughlin, J. F. (2022, September). Footwear design considerations for an aging population from user experience, service, and technology aspects. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting (Vol. 66, No. 1, pp. 1667-1672). Sage CA: Los Angeles, CA: SAGE Publications.  [Source]
  34. Malki, A., Verkerke, G. J., Dekker, R., & Hijmans, J. M. (2023). Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation: A focus group study. PLoS One.  [Source]
  35. Mandal, A. (2020). … of Diabetic foot related complications among People with Diabetes Attending a Tertiary Care Hospital in Southern India: Foot Care Knowledge in Diabetes ….  [Source]
  36. Mauricio, D., Alonso, N., & Gratacòs, M. (2020). Chronic diabetes complications: the need to move beyond classical concepts. Trends in Endocrinology & Metabolism. [ Source]
  37. McCann, J. & Bryson, D. (2022). Smart clothes and wearable technology. [Source]
  38. Menz, H. B. (2021). Foot problems, footwear, and falls. Falls in Older People: Risk Factors, Strategies for Prevention and Implications for Practice, 119-129. [Source]
  39. Miranda, C., Da Ros, R., & Marfella, R. (2021). Update on prevention of diabetic foot ulcer. Archives of Medical Sciences. Atherosclerotic Diseases, 6, e123.  [Source]
  40. Moore, Z., Avsar, P., Wilson, P., Mairghani, M., O'Connor, T., Nugent, L., & Patton, D. (2021). Diabetic foot ulcers: treatment overview and cost considerations. Journal of Wound Care, 30(10), 786-791.  [Source]
  41. Naemi, R., Chockalingam, N., Lutale, J. K., & Abbas, Z. G. (2020). Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania. BMJ Open Diabetes Research and Care, 8(1), e001122.  [Source]
  42. Najafi, B. & Mishra, R. (2021). Harnessing digital health technologies to remotely manage diabetic foot syndrome: a narrative review. Medicina.  Source
  43. Ning, S. (2024). Design of textile-fabricated diabetic insole for enhancing foot thermal comfort.  [Source]
  44. Nouman, M., Dissaneewate, T., Chong, D. Y. R., & Chatpun, S. (2021). Effects of custom-made insole materials on frictional stress and contact pressure in diabetic foot with neuropathy: results from a finite element analysis. Applied Sciences.  [Source]
  45. Orr, R., Maupin, D., Palmer, R., Canetti, E. F., Simas, V., & Schram, B. (2022). The impact of footwear on occupational task performance and musculoskeletal injury risk: a scoping review to inform tactical footwear. International Journal of Environmental Research and Public Health, 19(17), 10703.  [Source]
  46. Pervez, W. (2022). Designing for disassembly–adversarial design and future directions for athleisure clothing in a circular economy.  [Source]
  47. Reardon, R., Simring, D., Kim, B., Mortensen, J., Williams, D., & Leslie, A. (2020). The diabetic foot ulcer. Australian journal of general practice, 49(5), 250-255.  [Source]
  48. Reichenbach, S., Felson, D. T., Hincapié, C. A., Heldner, S., Bütikofer, L., Lenz, A., ... & Jüni, P. (2020). Effect of biomechanical footwear on knee pain in people with knee osteoarthritis: the BIOTOK randomized clinical trial. Jama, 323(18), 1802-1812.  [Source]
  49. Robert, A. A. & Al Dawish, M. A. (2020). The worrying trend of diabetes mellitus in Saudi Arabia: an urgent call to action. Current diabetes reviews.  [Source]
  50. Rodrigo‐Carranza, V., Hoogkamer, W., González‐Ravé, J. M., & González‐Mohíno, F. (2024). Relationship between advanced footwear technology longitudinal bending stiffness and energy cost of running. Scandinavian Journal of Medicine & Science in Sports, 34(6), e14687.  [Source]
  51. Rose, J. D. & Martorana, V. J. (2023). The Foot Book: The Complete Guide to Caring for Your Feet and Ankles. [Source]
  52. Rossboth, S., Lechleitner, M., & Oberaigner, W. (2021). Risk factors for diabetic foot complications in type 2 diabetes—a systematic review. Endocrinology, Diabetes & Metabolism, 4(1), e00175.  [Source]
  53. Rukmini, P. G., Hegde, R. B., Basavarajappa, B. K., Bhat, A. K., Pujari, A. N., Gargiulo, G. D., ... & Naik, G. R. (2024). Recent Innovations in Footwear and the Role of Smart Footwear in Healthcare—A Survey. Sensors, 24(13), 4301.  [Source]
  54. Sandhu, K., Srivastava, V., & Pal, M. (2020). Effect of shod walking on plantar pressure with varying insole.  [Source]
  55. Schaper, N. C., van Netten, J. J., Apelqvist, J., Bus, S. A., Hinchliffe, R. J., Lipsky, B. A., & IWGDF Editorial Board. (2020). Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes/metabolism research and reviews, 36, e3266.  [Source]
  56. Sousa, L. B., Almeida, I., Bernardes, R. A., Leite, T. R., Negrão, R., Apóstolo, J., ... & Parreira, P. (2023). A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration. Frontiers in Public Health, 11, 1061383.  [Source]
  57. Soyoye, D. O., Abiodun, O. O., Ikem, R. T., Kolawole, B. A., & Akintomide, A. O. (2021). Diabetes and peripheral artery disease: A review. World journal of diabetes, 12(6), 827.  [Source]
  58. Stokes, V. K. (2020). Introduction to plastics engineering. [Source]
  59. Tsaklis, P. V., & Tentolouris, N. (2024). Biomechanics of the Diabetic Foot: The Road to Foot Ulceration. In The Diabetic Foot: Medical and Surgical Management (pp. 233-252). Cham: Springer International Publishing.  [Source]
  60. Ulbrecht, J. S. & Bus, S. A. (2020). Footwear and Orthoses for People with Diabetes. The Foot in Diabetes. [Source]
  61. van Netten, J. J., Raspovic, A., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Sacco, I. C., & Bus, S. A. (2020). Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review. Diabetes/metabolism research and reviews, 36, e3270.  [Source]
  62. Van Rensburg, M. L., Nkomo, S. P. L., & Mkhize, N. M. (2020). Life cycle and End-of-Life management options in the footwear industry: A review. Waste Management & Research, 38(6), 599-613.  [Source]
  63. Wukich, D. K., Raspovic, K. M., Jupiter, D. C., Heineman, N., Ahn, J., Johnson, M. J., ... & Nakonezny, P. A. (2022). Amputation and infection are the greatest fears in patients with diabetes foot complications. Journal of Diabetes and its Complications, 36(7), 108222.  [Source]
  64. Yick, K. L. & Tse, C. Y. (2021). The use of textiles and materials for orthopedic footwear insoles. Handbook of Footwear Design and Manufacture. [Source]
  65. Zhang, L., Yick, K., Li, P., Yip, J., & Ng, S. (2022). Foot deformation analysis with different load-bearing conditions to enhance diabetic footwear designs. Plos one.  [Source]
  66. Zhang, X., Wang, H., Du, C., Fan, X., Cui, L., Chen, H., ... & Deng, W. (2022). Custom-molded offloading footwear effectively prevents recurrence and amputation, and lowers mortality rates in high-risk diabetic foot patients: A multicenter, prospective observational study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 103-109.  [Source]
  67. Zolfagharian, A., Lakhi, M., Ranjbar, S., & Bodaghi, M. (2021). Custom shoe sole design and modeling toward 3D printing. International Journal of Bioprinting, 7(4).  [Source]
  68. Zubair, M. & Fatima, F. (2021). Molecular mechanism and biomechanics of the diabetic foot: the road to foot ulceration and healing. Diabetic Foot Ulcer: An Update. [ Source]
  69. Zwaferink, J. B., Custers, W., Paardekooper, I., Berendsen, H. A., & Bus, S. A. (2020). Optimizing footwear for the diabetic foot: Data-driven custom-made footwear concepts and their effect on pressure relief to prevent diabetic foot ulceration. PLoS One, 15(4), e0224010.  [Source]
International Design Journal
Volume 13, Issue 4
July and August 2023
Pages 367-383

Files

Share

How to cite

Statistics