Abstract：
OBJECTIVE: Incorrectly fitting footwear (IFF) poses a risk of trauma to at-risk feet with diabetes. The aim of this systematic review was to summarise and assess the evidence that IFF is a statistically significant cause of ulceration.
METHODS: We searched PubMed, Scopus, Web of Science and Google Scholar for English-language peer-reviewed studies reporting the number or percentage of people with diabetes-related foot ulceration (DFU) attributed to wearing IFF and included a physical examination of the footwear worn. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa scale.
RESULTS: 4318 results were retrieved excluding duplicates with 45 studies shortlisted. Ten studies met the inclusion criteria with most rated as fair (n = 6) or good (n = 3). There is some evidence that DFU is significantly associated with IFF, but this is limited: only 3 of 10 included studies found a statistically significant percentage of those with DFU were wearing IFF or inappropriate footwear which included fastening, material, type or fit (15.0%-93.3%). Risk of bias in these three studies ranged from \'fair\' to \'poor\'. IFF definitions were often unreported or heterogeneous. Only one study reported IFF-related ulcer sites: 70% were at plantar hallux/toes and 10% at plantar metatarsal heads.
CONCLUSIONS: There is some evidence that IFF is a cause of DFU, but further research is needed, which defines IFF, and methodically records footwear assessment, ulcer location and physical activity. Researchers need to uncover why IFF is worn and if this is due to economic factors, a need for footwear education or other reasons.
METHODS: We searched PubMed, Scopus, Web of Science and Google Scholar for English-language peer-reviewed studies reporting the number or percentage of people with diabetes-related foot ulceration (DFU) attributed to wearing IFF and included a physical examination of the footwear worn. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa scale.
RESULTS: 4318 results were retrieved excluding duplicates with 45 studies shortlisted. Ten studies met the inclusion criteria with most rated as fair (n = 6) or good (n = 3). There is some evidence that DFU is significantly associated with IFF, but this is limited: only 3 of 10 included studies found a statistically significant percentage of those with DFU were wearing IFF or inappropriate footwear which included fastening, material, type or fit (15.0%-93.3%). Risk of bias in these three studies ranged from \'fair\' to \'poor\'. IFF definitions were often unreported or heterogeneous. Only one study reported IFF-related ulcer sites: 70% were at plantar hallux/toes and 10% at plantar metatarsal heads.
CONCLUSIONS: There is some evidence that IFF is a cause of DFU, but further research is needed, which defines IFF, and methodically records footwear assessment, ulcer location and physical activity. Researchers need to uncover why IFF is worn and if this is due to economic factors, a need for footwear education or other reasons.
摘要：
目标：错误地装配鞋类（IFF）会对患有糖尿病的双脚造成创伤。本系统综述的目的是总结和评估IFF是溃疡的统计学重要原因的证据。
方法：我们搜索了PubMed，Scopus,WebofScience和GoogleScholar的英语同行评审研究报告了与糖尿病相关的足部溃疡（DFU）归因于穿着IFF的人数或百分比，并包括对所穿鞋类的身体检查。两名独立审查员使用纽卡斯尔-渥太华量表评估了偏见的风险。
结果：检索到4318项结果，排除了45项入围研究的重复项。十项研究符合纳入标准，大多数被评为一般（n=6）或良好（n=3）。有一些证据表明DFU与IFF显著相关，但这是有限的：10项纳入研究中只有3项发现，DFU患者中，有统计学意义的百分比穿着IFF或不合适的鞋类，包括紧固，材料,类型或适合（15.0%-93.3%）。在这三项研究中，偏倚的风险范围从“公平”到“差”。IFF定义通常未报告或异质。只有一项研究报告了IFF相关的溃疡部位：70％位于足趾/脚趾，10％位于足底meta头。
结论：有一些证据表明IFF是DFU的原因，但是需要进一步的研究，它定义了IFF，并有条不紊地记录鞋类评估，溃疡部位和体力活动。研究人员需要揭示为什么要穿IFF，如果这是由于经济因素，需要鞋类教育或其他原因。
方法：我们搜索了PubMed，Scopus,WebofScience和GoogleScholar的英语同行评审研究报告了与糖尿病相关的足部溃疡（DFU）归因于穿着IFF的人数或百分比，并包括对所穿鞋类的身体检查。两名独立审查员使用纽卡斯尔-渥太华量表评估了偏见的风险。
结果：检索到4318项结果，排除了45项入围研究的重复项。十项研究符合纳入标准，大多数被评为一般（n=6）或良好（n=3）。有一些证据表明DFU与IFF显著相关，但这是有限的：10项纳入研究中只有3项发现，DFU患者中，有统计学意义的百分比穿着IFF或不合适的鞋类，包括紧固，材料,类型或适合（15.0%-93.3%）。在这三项研究中，偏倚的风险范围从“公平”到“差”。IFF定义通常未报告或异质。只有一项研究报告了IFF相关的溃疡部位：70％位于足趾/脚趾，10％位于足底meta头。
结论：有一些证据表明IFF是DFU的原因，但是需要进一步的研究，它定义了IFF，并有条不紊地记录鞋类评估，溃疡部位和体力活动。研究人员需要揭示为什么要穿IFF，如果这是由于经济因素，需要鞋类教育或其他原因。
