Study participants made visits every 17 weeks to a study team that included a foot care specialist. Patients and their health care providers were informed about any foot lesions, and the patients were referred to the providers for treatment.

Reiber noted that the extra attention given the study participants may have contributed to the overall low rate of ulcers in all three groups, regardless of what kind of shoes they wore.

It is estimated that about 17 million Americans have diabetes. Footwear is a concern for those with diabetes because the condition may cause peripheral nerve damage and poor blood circulation, leaving patients with little to no feeling in their feet. As a result, pressure from shoes and minor trauma are more likely to lead to ulcers.

Half of U.S. adults with diabetes have one or more foot risk conditions and 10 percent of these adults report a prior foot ulcer, similar to the study population. These ulcers can become severe enough to require amputation. People with diabetes account for more than 90,000 of the roughly 134,000 lower-limb amputations performed yearly in the United States. About half these diabetes-related amputations are attributed to poorly fitting footwear.

Foot care specialists routinely recommend that patients with diabetes and foot risk factors buy special "depth" shoes with extra room in the toes. Since Medicare adopted the Therapeutic Shoe Bill in 1993, the cost of these shoes, along with insertsup to $318 per yearis covered for certain patients who do not have severe foot deformities.

"The evidence suggests that a shift in the diabetic foot care paradigm may be in order," said co-principal investigator Douglas Smith, MD, of the University of Washington. In light of the findings, he suggested the clinical emphasis should be on ensuring that all persons wi
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Contact: Jeri Rowe
jeri.rowe@med.va.gov
206-764-2435
VA Research Communications Service
14-May-2002