Footwear Appropriateness, Preferences and Foot Ulcer Risk Among Adult Diabetics at Makati Medical Center Outpatient Department


  • Joie Dj Quiba Isip Makati Medical Center
  • Milldeanna de Guzman Makati Medical Center
  • Andres Ebison Jr. Makati Medical Center
  • Carolyn Narvacan-Montano Makati Medical Center


footwear, diabetes mellitus, foot ulcer


*Visual Abstracts prepared by Dr. Jerico Gutierrez

Objective. To determine general and clinical characteristics associated with the use of inappropriate footwear among Filipino patients with diabetes.

Methodology. Adult patients with diabetes were recruited. Comprehensive foot examination was done checking on foot deformities, neuropathies and peripheral arterial disease. Footwear was then examined as to length and width. Appropriateness of footwear to patient’s foot was measured using International Working Group on the Diabetic Foot (IWGDF) criteria.

Results. We classified 170 adults with diabetes based on foot ulcer risk classification of IWGDF. In this population, 62% of respondents were at risk for foot ulcer. Flipflops are the primary choice of footwear among 82% and 47% of the respondents for indoor and outdoor footwear respectively. Inappropriate footwear was see in 91% of the patients. Binary logistic regression showed insufficient evidence to determine an association between the use of inappropriate footwear and patient sex, educational attainment, foot care evaluation and examination. Foot ulcer risk classification showed a trend for higher group levels to wear inappropriate footwear. 

Conclusion. Flipflops and sandals are the primary preferences of the participants. Majority (91%) of the participants wear inappropriate footwear. This finding were due to multifactorial causes: preference, climate, economic reasons, and foot ulcer risk category. Educational attainment and foot care education did not improve the statistics of footwear appropriateness.



Download data is not yet available.

Author Biographies

Joie Dj Quiba Isip, Makati Medical Center

Fellow-in-Training, Internal Medicine, Section of Endocrinology

Milldeanna de Guzman, Makati Medical Center

Fellow-in-Training, Internal Medicine, Section of Endocrinology

Andres Ebison Jr., Makati Medical Center

Fellow-in-Training, Internal Medicine, Section of Endocrinology

Carolyn Narvacan-Montano, Makati Medical Center

Section of Endocrinology, Diabetes and Metabolism


International Diabetes Federation Consultative Section, International Working Group on the Diabetic Foot. Diabetes and foot care: Time to act. IDF, 2005.

Peters EJG, Lavery LA. Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care. 2001;24(8):1442-7.

Tapp RJ, Zimmet P, Harper A, et al. Diabetes care in Australian population. Frequency of screening examinations for eye and foot complications of diabetes. Diabetes Care. 2004; 27(3):688-93.

Bakker K, Appelqvist J, Schaper J, for the International Working Group on the Diabetic Foot Editorial Boardt. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28(Suppl 1):225–31.

Morbach S, Lutale JK, Viswanathan V, et al. Regional differences in risk factors and clinical presentation of diabetic foot lesions. Diabetic Med. 2004;21(1):91-5.

MacFarlane RM, Jeffcoate WJ. Factors contributing to the presentation of diabetic foot ulcers. Diabetic Med. 1997;14(10):867–70.<867::AID-DIA475>3.0.CO;2-L.

McGill M, Molyneaux L, Yue DK. Which diabetic patients should receive podiatry care? An objective analysis. Intern Med J. 2005;35(8):451-6.

Reiber G. Who is at risk of limb loss and what to do about it? J Rehabil Res Dev. November 1994;31(4):357–62.

Nixon BP, Armstrong DG, Wendell C, et al. Do US Veterans wear appropriately sized shoes? The veterans affairs shoe size selection study. J Am Podiatr Med Assoc. 2006;96(4):290-2.

UNITE for Diabetes Philippines. Available at Accessed November 2015.

Mwandri MB. The outcome of using the 60-second diabetic foot screen to identify the diabetic foot at risk in Tanzania. Wound Healing Southern Africa. 2012;5(2):86-9.

Boulton A, Armstrong D, Albert S, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679-85.

Instructions and fitting tips. Available at Accessed March 2016.

Chandalia HB, Singh D, Kapoor V, Lamba PS. Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics. Int J Diabetes Dev Ctries. 2008;28(4):109–13.

Harrison SJ, Cochrane L, Abboud RJ, Leese GP. Do patients with diabetes wear shoes of the correct size? Int J Clin Pract. 2007;61(11):1900-4.

Bus SA, Armstrong DG, van Deursen RW, et al. IWGDF Guidance on footwear and offloading interventions to prevent and heal foot ulcer in patients with diabetes. Available at Accessed February 14,2016.

Parnés A. If the shoe fits … footwear and patients with diabetes. Int J Clin Pract. 2007;61(11):1779–90.

Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev. 2014;12:1-55.

Hämäläinen H, Rönnemaa T, Toikka T, Liukkonen I. Long-term effects of one year of intensified podiatric activities on foot care knowledge and self-care habits in patients with diabetes. The Diabetes Educator. 1998;24(6): 734-40.

Lincoln NB, Radford KA, Game FL, Jeffcoate WJ. Education for secondary prevention of foot ulcers in people with diabetes: A randomized controlled trial. Diabetalogia. 2008;51(11):1954-61.



How to Cite

Isip, J. D. Q., de Guzman, M., Ebison Jr., A., & Narvacan-Montano, C. (2016). Footwear Appropriateness, Preferences and Foot Ulcer Risk Among Adult Diabetics at Makati Medical Center Outpatient Department. Journal of the ASEAN Federation of Endocrine Societies, 31(1), 37. Retrieved from



Original Articles