Improving adherence to wearing custom-made footwear in people with diabetes at high risk for foot ulceration

Foot ulceration is one of the major health problems for people with diabetes mellitus and is an important precursor to foot infection and amputation. Up to 34% of people with diabetes experience a diabetic foot ulcer once in their lifetime, and with ulcer healing rates around 70% in 12 months, ulcer treatment is lengthy and complex. But even if an ulcer is healed, a recurrent foot ulcer develops in roughly 40% of the people within one year. Preventative treatment often involves the use of prescription custom-made footwear, aiming to reduce ulcer risk by redistributing and reducing foot pressures and providing proper fit. However, adherence to wearing the prescribed footwear is a known problem in this group. The first aim of this thesis therefore was to gain insight in the adherence of wearing custom-made footwear and the determinants of adherence in a group of people with diabetes with a high risk for plantar foot ulceration, and in a subgroup of people with diabetes, recently healed plantar foot ulcer and a Charcot midfoot deformity. Secondly, to gain insight in how adherence to wearing custom-made footwear in people with diabetes and a healed plantar ulcer can be improved by assessing the effects of motivational interviewing and the provision of custom-made footwear that is specifically designed for indoor use.