A 25-year-old woman with type 1 diabetes of 10 years' duration and a history of neuropathic ulceration, was very reluctant to wear bespoke shoes and denied that they would help to prevent ulceration. We explained the association between high plantar pressures, callus and ulceration and then measured plantar pressures when she was wearing her own shoes and when she was wearing trainerstyle shoes (Fig. 3.4a,b).
Once she saw the reduction of high pressures in the trainer-style shoes she agreed to wear them.
' In-shoe pressure measurement systems are invaluable in demonstrating the reduction of forefoot pressures in special shoes
• When dangerously high pressures are demonstrated to patients they are more likely to agree to change their style of footwear
• When high-tech apparatus is not available, using low-
Fig. 3.4 (a) Forefoot pressure measurements using EMED system reveal red areas of unacceptably high pressure in patient's own shoes, (b) The areas of high pressure are eliminated in a trainer-style shoe.
tech educational messages is also effective. An oudine of the patient's foot can be traced on paper, cut out and fitted into the patient's shoe: if it will not fit in the shoe, the patient can see clearly that the shoe is too small.
Patients' reasons for refusing to wear special shoes
• Too ugly and unfashionable
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