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01-12-2014 | Research | Uitgave 1/2014 Open Access

Journal of Foot and Ankle Research 1/2014

Patients’ Experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: an interpretative phenomenological analysis (IPA)

Journal of Foot and Ankle Research > Uitgave 1/2014
Joanne S Paton, Anne Roberts, Graham K Bruce, Jonathan Marsden
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-7-16) contains supplementary material, which is available to authorized users.

Competing interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors disclosed receipt of the following financial support for the research of this article: A CAT Clinical Lectureship Fellowship awarded by the National Institute of Health Research.

Authors’ contribution

JP conceived and designed the study, conducted the interviews, extracted and analysed the data and produced the first and final draft. AR participated in the development of the study design, the interpretation and analysis of data, the review of academic content, the production of the initial draft and edited the final draft. GB and JM participated in the development of the research design, critically reviewed the academic content and participated in producing the final draft. All authors read and approved the final manuscript.



Previous work has found that people with diabetes do not wear their therapeutic footwear as directed, but the thinking behind this behaviour is unclear. Adherence to therapeutic footwear advice must improve in order to reduce foot ulceration and amputation risk in people with diabetes and neuropathy. Therefore this study aimed to explore the psychological influences and personal experiences behind the daily footwear selection of individuals with diabetes and neuropathy.


An interpretative phenomenological analysis (IPA) approach was used to explore the understanding and experience of therapeutic footwear use in people living at risk of diabetic neuropathic foot ulceration. This study benefited from the purposive selection of a small sample of four people and used in-depth semi structured interviews because it facilitated the deep and detailed examination of personal thoughts and feelings behind footwear selection.


Four overlapping themes that interact to regulate footwear choice emerged from the analyses: a) Self-perception dilemma; resolving the balance of risk experienced by people with diabetes and neuropathy day to day, between choosing to wear footwear to look and feel normal and choosing footwear to protect their feet from foot ulceration; b) Reflective adaption; The modification and individualisation of a set of values about footwear usage created in the minds of people with diabetes and neuropathy; c) Adherence response; The realignment of footwear choice with personal values, to reinforce the decision not to change behaviour or bring about increased footwear adherence, with or without appearance management; d) Reality appraisal; A here and now appraisal of the personal benefit of footwear choice on emotional and physical wellbeing, with additional consideration to the preservation of therapeutic footwear.


For some people living at risk of diabetic neuropathic foot ulceration, the decision whether or not to wear therapeutic footwear is driven by the individual ‘here and now’, risks and benefits, of footwear choice on emotional and physical well-being for a given social context.

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