Smith D, Weinberger M, Katz B: A controlled trial to increase office visits and reduce hospitalization in diabetic patients. .J Gen Intern Med 2::232. ,1987. .
Gibbons G, Eliopoulos GM: “Infection of the Diabetic Foot,” in Management of Diabetic Foot Problems, ed by GP Kozak, CS Hoar, JL Rowbotham, p 97, WB Saunders, Philadelphia. ,1984. .
Block P: The diabetic foot ulcer: a complex problem with a simple treatment approach. .Mil Med 146::644. ,1981. .
National Diabetes Advisory Board: The National Long-Range Plan to Combat Diabetes, p 88, National Institutes of Health, Bethesda, MD. ,1987. .
Most RS, Sinnock P: The epidemiology of lower extremity amputations in diabetic individuals. .Diabetes Care 6::87. ,1983. .
van Houtum WH, Rauwerda JA, Ruwaard D, et al: Reduction in diabetes-related lower-extremity amputations in the Netherlands: 1991–2000. .Diabetes Care 27::1042. ,2004. .
van Houtum WH, Lavery LA: Regional variation in the incidence of diabetes-related amputations in The Netherlands. .Diabetes Res Clin Pract 31::125. ,1996. .
Lavery LA, van Houtum WH, Ashry HR, et al: Diabetes-related lower-extremity amputations disproportionately affect Blacks and Mexican Americans. .South Med J 92::593. ,1999. .
Armstrong DG, Lavery LA, van Houtum WH, et al: Seasonal variations in lower extremity amputation. .J Foot Ankle Surg 36::146. ,1997. .
Reiber GE: The epidemiology of diabetic foot problems. .Diabet Med 13: (suppl 1):S6. ,1996. .
Armstrong DG: Is diabetic foot care efficacious or cost-effective?. Ostomy Wound Manage 47::28. ,2001. .
Burns SL, Leese GP, McMurdo ME: Older people and ill-fitting shoes. .Postgrad Med 78::344. ,2002. .
Chantelau E, Gede A: Foot dimensions of elderly people with and without diabetes mellitus: a data basis for shoe design. .Gerontology 48::241. ,2002. .
Armstrong DG, Lavery LA, Vela SA, et al: Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. .Arch Intern Med 158::289. ,1998. .
Young MJ, Breddy JL, Veves A, et al: The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: a prospective study. .Diabetes Care 17::557. ,1994. .
Young MJ, Boulton AJ, MacLeod AF, et al: A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. .Diabetologia 36::150. ,1993. .
Kirkwood BR: Essentials of Medical Statistics, Blackwell, Oxford. ,1988. .
Uccioli L, Faglia E, Monticone G, et al: Manufactured shoes in the prevention of diabetic foot ulcers. .Diabetes Care 18::1376. ,1995. .
Lavery LA, Vela SA, Fleischli JG, et al: Reducing plantar pressure in the neuropathic foot: a comparison of footwear. .Diabetes Care 20::1706. ,1997. .
Perry JE, Ulbrecht JS, Derr JA, et al: The use of running shoes to reduce plantar pressures in patients who have diabetes. .J Bone Joint Surg Am 77::1819. ,1995. .
Rossi W: The high incidence of mismated feet in the population. .Foot Ankle 4::105. ,1983. .
Kusumoto A, Ashizawa K: Foot and shoe size of Japanese female university students. .J Hum Ergol (Tokyo) 17::91. ,1988. .
Poorly fitting footwear has frequently been cited as an etiologic factor in the pathway to diabetic foot ulceration. However, we are unaware of any reports in the medical literature specifically measuring shoe size versus foot size in this high-risk population. We assessed the prevalence of poorly fitting footwear in individuals with and without diabetic foot ulceration. We evaluated the shoe size of 440 consecutive patients (94.1% male; mean ± SD age, 67.2 ± 12.5 years) presenting to an interdisciplinary teaching clinic. Of this population, 58.4% were diagnosed as having diabetes, and 6.8% had active diabetic foot ulceration. Only 25.5% of the patients were wearing appropriately sized shoes. Individuals with diabetic foot ulceration were 5.1 times more likely to have poorly fitting shoes than those without a wound (93.3% versus 73.2%; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–21.9; P = .02). This association was also evident when assessing only the 32.3% of the total population with diabetes and loss of protective sensation (93.3% versus 75.0%; OR, 4.8; 95% CI, 1.1–20.9; P = .04). Poorly fitting shoes seem to be more prevalent in people with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. This implies that appropriate meticulous screening for shoe-foot mismatches may be useful in reducing the risk of lower-extremity ulceration. (J Am Podiatr Med Assoc 96(4): 290–292, 2006)