Sustainable Innovation: Footwear Material Choices and Design for People Suffering with Diabetes

Recent research has shown that foot complications are common in people with diabetes, with this being more prominent in less developed countries (Forlee, 2010; Rayman 2004). As a result, there has been an increase in multidisciplinary foot-care teams being set up across the world to advise patients on the proper type of footwear to use or to avoid (Boulton, 2005; Tyrrell, 2009). However, in Africa and other less developed countries, there is still lack of awareness of foot care among patients and health care providers, leading to further foot complications (Abbas, 2007). To resolve this, the International Diabetes Federation and the International Working Group on the Diabetic Foot (2005) advocate new research so as to collect data on diabetic foot complications and to identify appropriate preventative measures. Previous studies showed that improper footwear is probably the reason for high foot ulceration and amputation among diabetics; and many foot problems could still be potentially averted by wearing appropriate shoes (Caselli, 2011; Vernon, 2007). As a result, the authors argue that proper footwear is an essential part of rehabilitative care and an important consideration in the clinical management of diabetic foot disorders.

The aim of this work is to first explore current medical knowledge and practice concerning the use of orthopaedic footwear to manage diabetic foot problems, particularly in Nigeria. This survey was conducted from August to September 2012, involving three government hospitals at Kaduna State in Nigeria. A framework consisting of participants selection criteria, a Standard Operating Procedure and research ethical consent form was prepared and used as a guide during the survey. Six doctors from the three hospitals were interviewed by means of structured questionnaires and the outcome was analyzed. This approach was used by the authors because of its potential to elicit a wide range of information from the medical experts despite the small sampling.

The pilot survey showed that the percentage of diabetic patients suffering from foot problems ranged from 10% to 48%. Five out of the six doctors indicated that they encountered diabetic patients with foot deformities like charcot foot, hammer toes, ulcers, etc. that regular footwear was unable to accommodate. The authors also found that no footwear programme or service has been made available in Nigeria, of which could potentially educate or improve diabetic foot complications. In addition, the provision of protective footwear through retail channels is also completely non-existent, and medical practitioners did not have the knowledge of specialist footwear manufacturers or technicians in the country. More importantly, the doctors would welcome such a programme or service to improve their patients’ foot condition. As a pioneering survey, these findings provide areas for future research that could potentially increase awareness among health care providers in Nigeria for diabetic patients suffering from foot complications. Strategies and plans on how the authors will conduct further research, including a framework to design and develop comfortable and affordable footwear is also proposed.