Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK.
Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
J Foot Ankle Res. 2020 Dec 4;13(1):70. doi: 10.1186/s13047-020-00439-3.
Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal footwear length available to the foot. We summarised the literature on toe gaps in studies assessing footwear worn by people with diabetes, the methods used to measure both foot length and internal footwear length and identify ambiguities which may impact on toe gap assessment in clinical practice, and suggest pragmatic solutions.
The Google Scholar database was searched to April 2020 for peer-reviewed studies using keywords related to incorrectly fitting or ill-fitting and diabetes, foot and ulcer which returned 979 results. Included studies within this narrative review encompassed toe gap measurement to assess footwear worn by people with diabetes.
A total of eight studies were included after full paper review. Toe gap ranges as used in assessments of footwear worn by people with diabetes vary, with a minimum of 1.0-1.6 cm and a maximum of 1.5-2.0 cm, as do methods of measuring internal footwear length. Only three published studies suggested possible measuring devices.
Toe gap ranged as used when assessing footwear fit in people with diabetes vary and a gold standard device for internal footwear length measurement has yet to emerge. International guidelines provide welcome standardisation, but further research is needed to evaluate both the effect of toe gap ranges upon pressure, plantar stress response and ulceration and available measuring devices to facilitate development of toe gap measurement protocols that may further enhance consistency in practical assessments.
合适的鞋码对于预防糖尿病相关的足部溃疡至关重要。一个重要的因素是脚趾间隙，即足部长度和鞋子内部可供足部伸展的长度之间的差异。我们总结了评估糖尿病患者所穿鞋的研究中关于脚趾间隙的文献，这些文献涉及用于测量足部长度和鞋子内部长度的方法，并确定了可能影响临床实践中脚趾间隙评估的模糊点，并提出了实用的解决方案。
我们使用与不合适或不合脚以及糖尿病、足部和溃疡相关的关键词，对 2020 年 4 月之前在 Google Scholar 数据库中发表的同行评审研究进行了检索，共检索到 979 篇结果。本综述纳入了评估糖尿病患者穿鞋的脚趾间隙测量研究。
经过全文审查，共有 8 项研究被纳入。在评估糖尿病患者穿鞋时使用的脚趾间隙范围差异很大，最小值为 1.0-1.6cm，最大值为 1.5-2.0cm，测量鞋子内部长度的方法也不同。只有 3 项已发表的研究提出了可能的测量设备。
在评估糖尿病患者的鞋子合脚度时使用的脚趾间隙范围存在差异，而且还没有出现用于测量鞋子内部长度的黄金标准设备。国际指南提供了值得欢迎的标准化，但仍需要进一步研究来评估脚趾间隙范围对压力、足底应力反应和溃疡的影响，以及可用的测量设备，以促进制定可能进一步提高实际评估一致性的脚趾间隙测量方案。
