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Independent Factors Associated with Wearing Different Types of Outdoor Footwear in a Representative Inpatient Population: a Cross-Sectional Study Alex L

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Independent Factors Associated with Wearing Different Types of Outdoor Footwear in a Representative Inpatient Population: a Cross-Sectional Study Alex L Barwick et al. Journal of Foot and Ankle Research (2018) 11:19 https://doi.org/10.1186/s13047-018-0260-7 RESEARCH Open Access Independent factors associated with wearing different types of outdoor footwear in a representative inpatient population: a cross-sectional study Alex L. Barwick1*, Jaap J. van Netten2,3,4,5, Lloyd F. Reed2,3 and Peter A. Lazzarini2,3,5,6 Abstract Background: Footwear can have both a positive and negative impact on lower limb health and mobility across the lifespan, influencing the risk of foot pain, ulceration, and falls in those at risk. Choice of footwear can be influenced by disease as well as sociocultural factors, yet few studies have investigated the types of footwear people wear and the profiles of those who wear them. The aim of this study was to investigate the prevalence and factors associated with outdoor footwear type worn most often in a representative inpatient population. Methods: This study was a secondary data analysis of a cohort of 733 inpatients that is highly representative of developed nations’ hospitalised populations; 62 ± 19 years, 55.8% male, and 23.5% diabetes. Socio-demographic, medical history, peripheral arterial disease, peripheral neuropathy, foot deformity, foot ulcer history, amputation history and past foot treatment variables were collected. Participants selected the footwear type they mostly wore outside the house in the previous year from 16 types of footwear. Multivariate logistic regression identified independent factors associated with outdoor footwear types selected. Results: The most common outdoor footwear types were: running shoes (20%), thongs/flip flops (14%), walking shoes (14%), sandals (13%) and boots (11%). Several socio-demographic, medical history and foot-related factors were independently associated (Odds Ratio; 95% Confidence Interval)) with different types of footwear. Running shoes were associated with male sex (2.7; 1.8–4.1); thongs with younger age (0.95 for each year; 0.94–0.97), being female (2.0; 1.2–3.1) and socio-economic status (3.1; 1.2–7.6); walking shoes with arthritis (1.9; 1.2–3.0); sandals with female sex (3.8; 2.3–6.2); boots with male sex (9.7; 4.3–21.6) and inner regional (2.6; 1.3–5.1) and remote (3.4; 1.2–9.5) residence (all, p <0.05). Conclusions: We profiled the types of outdoor footwear worn most in a large diverse inpatient population and the factors associated with wearing them. Sex was the most consistent factor associated with outdoor footwear type. Females were more likely to wear thongs and sandals and males boots and running shoes. Overall, this data gives insights into the socio-demographic, medical and other health factors that are related to footwear choice in a large diverse population primarily of older age. Keywords: Footwear, Inpatient, Sex, Arthritis, Neuropathy, Diabetes, Running shoes, Flip flops, Walking shoes, Sandals * Correspondence: [email protected] 1School of Health and Human Sciences, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225, Australia Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Barwick et al. Journal of Foot and Ankle Research (2018) 11:19 Page 2 of 8 Background footwear types worn most in the year prior to hospitalisa- Footwear can impact lower limb health and general tion in a large representative inpatient population. This was mobility both positively and negatively across the life- a secondary data analysis of a multi-site cross-sectional span [1]. Different footwear features have an effect on observational study that investigated foot disease in an the biomechanics of standing and gait and hence can in- inpatient population, and has been described in detail fluence musculoskeletal function and dysfunction [2, 3]. elsewhere [24, 25]. Briefly, on one designated study day, all As a result, footwear is of relevance to a diverse range of adult inpatients admitted into hospital for any medical rea- population groups. Certain footwear can contribute to son (except those with cognitive deficits, in maternity and the development of pain [4], complications of diabetes in psychiatric wards) in five public hospitals in Queensland including ulceration [5], and imbalance that increases (Australia) were invited to participate [24]. 883 eligible par- the risk of falls [6, 7]. Accordingly, footwear displaying ticipants were invited and 733 (83%) consented. The demo- certain features are often recommended in the prevention graphic, social determinant and medical history make-up of and management of these conditions in specific popula- this sample has been reported to be highly representative of tions [8–12]. typical inpatient populations present in developed nations Footwear can be classified based on distinctive combina- [24–26]. Self-reported history and foot physical examin- tions of features into types such as sandals and boots [13]. ation was performed using a validated data collection in- Outdoor footwear requires features that protect the foot strument (the Queensland Foot Disease Form) [24, 25, 27]. from the external environment, but has further require- The items contained in this instrument have demonstrated ments to promote lower limb health and mobility. Such at least moderate criterion validity, inter and intra-rater requirements include: adequate width, depth and length to reliability in two different studies [24, 27]. accommodate the foot; a soft, flexible and protective upper; The self-reported explanatory variables were grouped low heel height; stable heel counter and limited available into the domains of socio-demographics (age, sex, indi- torsion for overall shoe stability; adequate outsole grip to genous status, country of birth, socioeconomic status, prevent slipping; and being fit for purpose [1, 12]. Footwear geographical remoteness), medical conditions history (dia- also has individualised psychosocial requirements, as choice betes, hypertension, dyslipidaemia, myocardial infarct, of footwear type is also influenced by sociocultural, psycho- cerebrovascular accident, chronic kidney disease, cancer, logical and other health factors [14, 15]. arthritis, depression, smoking, mobility impairment, vision For some populations complying with recommended impairment), and past foot treatment in the year prior to footwear features can be challenging, such as older people hospitalisation (by podiatrist, general practitioner, special- and those with arthritis. For example, foot deformity may ist physician, surgeon, nurse, orthotist and other) [24, 25]. change the shape of the foot causing difficulty in fitting The clinically-diagnosed explanatory variables were all standard prefabricated footwear [16]. Such constraints in foot-related conditions and obtained following physical footwear choices have also been shown to affect individu- examination, including: amputation history, foot ulcer ality, well-being and quality of life [16]. history (current or previous), peripheral artery disease Some previous research has investigated the outdoor (PAD) severity, peripheral neuropathy and foot deformity. footwear worn by specific patient groups. Those with arth- PAD severity was diagnosed based on a toe systolic pres- ritis have been found primarily to wear athletic or walking sure of < 70 mmHg, as mild (51-70 mmHg), moderate shoes [17, 18] and sandals [17, 19]. However, many people (31-50 mmHg) and critical (< 30 mmHg) PAD [28, 29]. with arthritis [19, 20], diabetes [21, 22], and older people Peripheral neuropathy was diagnosed as the failure to [23] often also wear inadequate footwear including sense a 10-g monofilament on at least two or more plantar thongs/flip flops [19–22] and slippers [22], or even go forefoot sites on one foot [30, 31]. The presence of three barefoot [21, 22]. To our knowledge, no previous research or more of the following in one foot was the basis for the has investigated the outdoor footwear worn in a large diagnosis of a foot deformity: small muscle wastage, bony diverse population and the profiles of those who wear prominence, prominent metatarsal heads, hammer or claw them. Information on the types of people who wear toes, limited joint mobility or Charcot deformity on one certain footwear in a representative inpatient population foot [30, 32]. may provide a starting point for further research into The outcome variable for this study was the self-reported potential causal influences on footwear choices that could footwear type worn most outside in the previous 12 months. be used to guide footwear behaviour change interventions Each participant was presented with a validated footwear in future. type picture chart [13], modified with permission to add drawings of socks only and barefoot (no footwear) options. Methods Participants were asked “from this chart displaying 16 dif- Theaimofthisstudywastoinvestigate the prevalence and ferent types of footwear, what is the type of shoes you have factors independently associated with different outdoor worn most outside the house over the past 12 months?” Barwick et al. Journal of Foot and Ankle Research (2018) 11:19 Page 3 of 8 [24, 25]. The chart displayed drawings and titles of walking Table 1 Main outdoor footwear types worn in the previous shoes, running shoes, oxford shoes, moccasins, boots, ugg 12 months boots, high heels, thongs/flip flops, slippers, backless slip- Rank Footwear Type Number % (95% CI) pers, court shoes, mules, sandals, bespoke footwear, socks 1 Running shoe 148 20.4% (17.6–23.5) only, and barefoot [13]. Participants were asked to select 2 Thongs/flip flops 103 14.2% (11.8–16.9) one type of footwear only [24, 25].
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