Adherence rates for wearing custom-made footwear are inadequate for patients with diabetes with a recently healed plantar foot ulcer, according to a study published online  in Diabetes Care.

Roelof Waaijman, from the University of Amsterdam, and colleagues assessed footwear use over seven days with a shoe-worn, temperature-based monitor in 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer, and custom-made footwear. An ankle-worn activity monitor simultaneously measured daily step count; adherence was evaluated based on the percentage of steps for which prescription footwear was worn.

The researchers found that mean adherence was 71%, with 61% adherence at home, over 3,959, and 87% adherence away from home, over 2,604 steps. The mean adherence at home was 28% for 35 patients with low adherence (less than 60%). Factors which were significantly correlated with adherence included lower body mass index, more severe foot deformity, and more appealing footwear.

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“This low adherence is a major threat for reulceration in this high-risk patient group,” the authors wrote. “Improvement of adherence could therefore include the prescription of specific protective footwear for indoors, while the importance of wearing prescription footwear should be further promoted.”