what-when-how
In Depth Tutorials and Information
8
shoes can be fitted correctly; however,
White and Mulley (1989)
found
that 25 per cent of community-dwelling older people were unable to get
to a shoe shop. These authors suggested the alternatives of mobile shoe
shops, where trained staff can go out into people's homes to it shoes,
or mail order, which may be more convenient.
Laboratory-based studies have examined gait, balance and tactile
perception in relation to features of shoe design, using volunteers under
controlled conditions. Interestingly, relatively thick, soft midsoles have
been found to interfere with position sense and contribute to instability,
as assessed by falls off a balance beam, raising questions about the
safety of athletic shoes. High-heeled shoes have been found in a gait
laboratory to lead to lateral instability and reduce stride length. These
findings have been demonstrated in the laboratory setting and it may be
that the risk of falls (attributed to footwear as the primary cause) increases
in the normal environment.
summary
The importance of good footwear, whether it be high-street retail footwear
or specialist therapeutic footwear, should be part of every consultation
with a patient presenting with foot pathology. In respect of the elderly and
the at risk person with, for example, diabetes or RA, footwear considera-
tions are vital in the maintenance of good foot health, reducing symptoms,
improving mobility and independence, and preventing limb-threatening
ulceration. It is clear from the evidence available that therapeutic footwear
is beneficial to people with diabetes (in preventing re-ulceration) and to
people with RA. However, to achieve the known benefits, it is crucial that
this footwear be worn sufficiently to maximize the potential for all these
benefits. Unfortunately, some people find that this footwear is unsuitable
because of its appearance. This problem can be overcome with better
footwear designs and also a more patient-focused approach to the con-
sultation (
Williams Nester and Ravey 2007b)
so the next chapter aims to
provide the practitioner with the knowledge and understanding of what
can be done to improve patient understanding and engagement with
appropriate footwear-wearing habits.
review questions
Reflection
1.
How would I describe the benefits of therapeutic footwear to a
patient with RA?
