Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Razel Bacuetes Milo, PhD., DNP., MSN, FNP-C, AAOPM-BC, APRN

Abstract

Background: Poorly fitted footwear contributes to falls in older adults living with diabetes, a population that experiences a baseline increased risk for falls in the presence of diabetic peripheral neuropathy. Despite this, baseline data reveals that 72% of older adults wear poorly fitted shoes with suboptimal shoe features1.

Purpose of Project: Adhering to current evidence-based practice guidelines, the two goals of this project were to educate older adults with diabetes on the characteristics of properly fitted footwear and to increase access to properly fitted shoes via a podiatry consultation. Subsequently, the increased number of optimal footwear will decrease fall risk.

EBP Model/Framework: This project is based on the Stetler model of evidence-based practice. The Stetler model places a heavy emphasis on research practicality. For this specific project, the Stetler model highlights external and confounding factors affecting older adults’ ability to wear properly fitting shoes.

Evidence-Based Interventions: Twenty-one new podiatry patients aged 65 and older with diabetes were given a footwear pre-test followed by an educational pamphlet and post-test. They were inquired about the number of falls experienced in the past six months, and their footwear was critiqued utilizing a validated Footwear Assessment Form2. Patients deemed to have footwear of poor fit or features were either ordered diabetic footwear, as deemed appropriate by the podiatrist, or guided on techniques to measure fit while retail purchasing.

Results: The number of properly fitted footwear increased from 9.52% to 57.89% post-project implementation. The average pre-test score was 60%, with an increase to 86% post-test. There was also a 22.8% reduction in the occurrence of falls. Of the eight patients who were ordered diabetic footwear, only one patient received their shoes within 3 months, indicating strong barriers.

Implications for Practice: Properly fitted footwear is a practical application for potentially life-saving harm reduction. All older adults with diabetes should receive a multifaceted approach to wearing properly fitted footwear and be referred to podiatry, especially if they have peripheral neuropathy, toe callus formations, previous foot ulcerations, foot deformity, amputation, or poor circulation. Additionally, the Footwear Assessment Form is a validated tool that can be used to help a provider determine shoe fit.

Conclusion: This project aimed to increase the usage of properly fitted footwear in adults over 65 with diabetes. After project implementation, the number of patients with properly fitted footwear increased and falls decreased. There were many barriers to receiving proper footwear, such as NP/PA limitations for ordering diabetic shoes, strict requirements for DME pick-up, and insurance denial. Providers are urged to be aware of these barriers and advocate for best practices for patients.

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Available for download on Friday, May 02, 2025

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