what-when-how
In Depth Tutorials and Information
Managing use issues with specialist footwear
There have been reports that specialist footwear services are failing to
meet the needs of the individual patient (
Bowker et al 1992
,
Disabled
Living Foundation 1991
) despite evidence to support the use of specialist
footwear to achieve good clinical outcomes. To achieve good clinical
outcomes means that patients have to wear their footwear for sufficient
time to maximize their potential for foot health improvement or mainte-
nance. That many patients choose not to wear this type of footwear may
be indicative of the lack of patient involvement in this therapeutic approach.
It has been recommended and observed that patients engage more
with this footwear if it is supplied through a multidisciplinary clinic (Williams
and Meacher 2001) or through the service that provides foot care (
Baker
and Leatherdale 1999
). A study by the authors (Williams and Nester 2006)
demonstrated that patient involvement from the design process through
to patient choice may be the key to getting patients to engage with this
type of footwear. However, the main factor may be the consultation
(Williams et al 2008). It is essential, therefore, that the practitioner involved
in providing footwear advice or assessing and supplying specialist thera-
peutic footwear should adopt a patient-focused approach that includes
the patient in the decision making process.
patient education and behaviour change
Footwear can be perceived by individuals in a variety of ways, depending
on what the shoes required offer. Footwear can provide a specific func-
tion, for example toe protection in safety shoes, but is for many people
inextricably linked to body image. In this respect, fashion trends can
dictate the style and type of footwear worn by individuals. The achieve-
ment of a good clinical outcome for the patient relies on managing
expectations, and practitioners must recognize that patients may have
different aims to theirs. For example, the clinician's aim may be to achieve
optimum it but the patient's objective may be comfort and/or style.
Practitioners need to understand that footwear does not just provide
protection for the foot or accommodate the orthoses that we might pre-
scribe; it is part of people's body image and important in respect of how
we feel about ourselves. As clinicians, we have to respect people's choice
to either engage in our advice or not. Rather than telling patients that their
footwear choices are bad, we should provide positive support for the
small changes that patients may achieve and continue to promote the
benefits of suitable footwear. It is only then that our patients may feel that
we are focused on them rather than on just their problems. Focusing on
