Patients often tell us, "I always wear closed shoes." Juan, the 47-year-old driver with type 2 diabetes in Episode 2 of the diabetic foot manual from Alianza Para El Salvataje del Pie Diabético (Peru), said the same thing. He still developed a wound, because a closed shoe that does not match the foot still creates pressure points.
For clinicians, that raises a charting question: when a patient presents with a foot wound, is footwear fit recorded anywhere in the note? This article looks at what to capture at the bedside, and how a wound care app on a phone or tablet can make that routine.
Why footwear belongs in the wound record
A wound location tells you where tissue broke down. Footwear history can help explain why. If the wound sits where a shoe rubs or presses, the treatment plan needs to address the shoe as well as the tissue. Patients with reduced sensation may not feel a wound forming, so the history they report is often incomplete.
Three foot shapes to recognize
The manual describes three common foot types, each needing a slightly different shoe:
- Egyptian: the big toe is longest. The shoe should taper gently from the big toe.
- Roman: the first three toes are about equal in length. A squarer toe-box fits best.
- Greek: the second toe is longer than the big toe. The shoe needs extra room at the second toe to avoid rubbing.
A quick note of foot type next to the wound site helps you spot a mismatch, for example a Greek foot in a tapered shoe with a lesion at the second toe.
A bedside fit check
Patients can measure at home, and you can verify it in the room:
- Trace the bare foot on paper.
- Mark the longest toe and the heel.
- Add about 1.5 cm. That is the true shoe size.
Then compare against the shoe the patient is wearing. The manual's rule is 1.5 cm of space beyond the longest toe, with no squeezing.
Footwear findings worth recording
The manual's do and don't lists translate into a simple checklist:
| Check | Safer finding | Risk finding |
|---|---|---|
| Shoe type | Closed, round toe | Open-toed sandal, flip-flop, high heel |
| Interior | No internal seams | Seams over pressure points |
| Fit | 1.5 cm past longest toe | Too tight or too loose |
| Heel | Low and wide | High or narrow |
| Closure | Velcro or laces | Straps cutting across the foot |
| Habits | Tested before buying | Untested purchases, barefoot walking |
Systemic numbers that sit beside the foot exam
The manual pairs footwear with metabolic control, since glucose protects the nerves and vessels that protect the feet. Targets it gives patients:
- Fasting glucose 80 to 130
- Post-meal glucose under 180
- HbA1c at or below 7% every three months
- Blood pressure under 130/80
- LDL under 100; HDL above 40 (men) or 50 (women); triglycerides under 150
Recording these alongside wound findings gives a fuller picture at each visit.
Making it practical on a phone
Charting during the visit beats reconstructing it afterward. Photograph the wound, note the foot type and shoe findings, and log the plan while the patient is still there. Tools built for mobile wound care documentation keep imaging, measurements, and notes in one workflow, which suits podiatrists and nurses moving between rooms.
The patient-facing lessons are simple enough to repeat at every visit: know your foot type, keep the 1.5 cm rule, never walk barefoot (not at home, not on the beach), and control glucose. You can see them presented through Juan's story in the original Episode 2 post.
Session 3 of the series covers the 10 Commandments of a Healthy Foot, daily habits that guard against dangers patients cannot feel.