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PLoS One. 2019 Feb 21;14(2):e0211140. doi: 10.1371/journal.pone.0211140. eCollection 2019.

Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study.

Author information

School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia.
School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia.
Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
Footmotion Podiatry Brisbane, Queensland, Australia.
Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia.



Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population.


This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups.


Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05).


Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.

Conflict of interest statement

This particular paper was a secondary analysis of the data from a larger study. Lloyd Reed had no potential competing interests when we performed the data collection for the larger study; however, when we performed the secondary data analysis for this particular paper, Lloyd Reed was employed part-time by Dominion Cross (Ascent footwear) to consult on an unrelated podiatry clinic. This part-time employment was completely unrelated to the larger study or this particular paper and we did not receive any funding, resources, correspondence or any influence from Dominion Cross on this paper at all. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

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