TABLE 3.

Characteristics and Findings of Included Studies on Footwear Worn by People With Diabetes in Low- and Middle-Income Countries

Authors, Year	Country and Setting	N and Sample Characteristics	Results
Bañuelos-Barrera et al. 2013⁴¹	Mexico,primary care center	N=87, 68% neuropathic51% with foot deformityMean 6 years of education	99% standard 82% [of footwear] in good condition 52% footwear material: leather 51% open shoes 63% flat shoe tips
Brilhante Batista et al. 2020⁴³	Brazil,basic health units	N=197, 91% with income at or less than minimum wage47% with less than 5 years of education	74% open-shoe sandal type 30% soft and closed-in shoes 4.1% tight closed-in shoes 1.0% pointy shoes
Chaurasia and Valame 2017⁴⁵	India,outpatient department of tertiary care hospital	N=350, 44% rural29% with graduate education66% neuropathic65% at moderate and 10% at high risk of DFU	65% more than 35 shore units 35% 16–35 shore units 0% 8–15 shore units (where shore units are a unit of hardness, and 8–15 was considered appropriate for footwear for people with diabetes)
Chellan et al. 2011⁵⁴	India,podiatry division of tertiary care center	N=361, all hospitalized for DFU93% neuropathic	80% sandals 16% closed shoes 2.5% therapeutic footwear 1.4% barefoot
de Sá Policarpo et al. 2014⁵⁵	Brazil,2 family health units	N=85, 72% with family income at or less than 2 minimum wages19% said comfortable and closed shoes ideal	87% open sandals 9.4% closed and soft 3.5% closed and tight
Gayle et al. 2012⁴²	Jamaica,hospital diabetes clinic	N=72, diabetes clinic attendees81% female32% with post-secondary education	Females: 88% slippers, 85% open-toe shoes, 85% broad round-toe shoes, 62% leather shoes, 62% sneakers, 43% high-heel shoes, 36% pointed- toe shoes, 22% canvas shoes, 17% plastic shoes Males: 93% slippers, 50% open-toe shoes, 71% broad round-toe shoes, 71% leather shoes, 57% sneakers, 50% pointed toe shoes, 21% canvas shoes, 6.9% plastic shoes, 6.9% work boots
Goie and Naidoo 2016⁴⁶	South Africa,outpatient department of diabetes clinic	N=280, 76% with altered limb sensation92% visited clinic monthly9.3% had previous DFU3.6% had previous amputation	83% sandals and flip-flops
Hirpha et al. 2020⁵¹	Ethiopia,outpatient department of medical center	N=370, 44% female39% illiterate53% urban31% farmers36% had previous DFU	23% sandals/slippers 28% shoes without socks
Isip et al. 2016²⁴	Philippines,outpatient department of medical center	N=170, 73% female47% college educated8.8% had active DFU62% at some risk of DFU	Females: 40% sandals, 31% flip-flops, 10% slip-ons, 8.8% ballet flats, 8.8% rubber shoes/sneakers, 0.7% pointed-toe shoes, 0.7% platform shoes Males: 35% sandals, 22% flip-flops, 20% slip-ons, 13% rubber shoes, 11% boat shoes
Jain and Rajagopalan 2018⁵⁶	India,hospital surgery department	N=38, regular foot patients at outpatient department21% female47% illiterate18% had previous amputation	32% Hawaii slippers 55% ordinary slippers/chappals 5.3% therapeutic footwear 2.6% shoes (ordinary) 2.6% sandals 2.6% no footwear
Jamani et al. 2018⁴⁴	Malaysia,diabetes clinic	N=166, 68% unemployed75% with income less than 1,500 Ringgit42% had foot problem	69% flip-flops or thongs 47% sandals 1.2% custom-made shoes
Kosachunhanun et al. 2012⁵⁷	Thailand,tertiary care diabetes clinic	N=438, patients visiting diabetes clinic78% at low risk of DFU3.9% had active DFU	67% slippers 8.8% low-heel shoes 3.5% sports shoes 1.4% high-heel shoes 19% others
Mustafa et al. 2017⁵⁸	Pakistan,hospital diabetes management center	N=90, 7.8% with dull foot sensation82% received foot care information11% had previous DFU	43% soft-heel shoes 41% sandals 12% leather shoes 2.2% high-heel shoes
Oliveira Neto et al. 2017⁴⁷	Brazil,diabetes and hypertension treatment center	N=235, patients attending health center34% with incomplete elementary schooling72% with diabetes duration for 10 years or longer38% with income less than minimum wage11% had previous DFU or amputation	59% open footwear
Prekumar et al. 2017⁵²	India,health center serving urban and rural patients	66 cases and 66 controls, all cases had ulcers due to footwearcontrols had diabetes but no DFU96% neuropathic35% of cases with diabetes duration less than 5 years53% cases, 62% controls use shoes 5 hours/day or less	Cases: 32% sandals with strap and toe grip; 18% sandals with strap, toe grip, and MCR insole; 29% Hawaii beach sandals; 6.1% sandals with MCR insole, soft outsole, and adjustable front and back straps; 3.0% slip-on shoes with covered uppers; 1.5% slip-in sandals without toe grip Controls: 26% sandals with strap and toe grip; 16% sandals with strap, toe grip, and MCR insole; 47% Hawaii beach sandals; 3.0% slip-on shoes with covered uppers
Rerkasem 2011⁵⁹	Thailand,referral hospital	N=511, 65% at low risk of DFU33% neuropathic13% had active DFU	67% Hawaii slippers 8.0% low-heel shoes 3.7% sports shoes 1.4% high-heel shoes
Ruiz Roque et al. 2017⁴⁸	Brazil,family health unit	N=63, all insulin users68% female67% never received foot care information	70% socks and closed-toe shoes
Saber and Daoud 2018⁴⁹	Iraq,hospital diabetes center	N=250, 71% urban31% neuropathic44% with diabetes duration less than 5 years20% had previous DFU	44% round-toe shoes 33% sandals
Saurabh et al. 2014⁶⁰	India,rural chronic disease clinic	N=103, patients attending clinic53% found to have high diabetes awareness5.8% at high risk of DFU2.9% had active DFU	79% slippers (chappals) 16% sandals without strap 3.0% sandals with strap or floaters 0% shoes or footwear with therapeutic insole
Sriyani et al. 2013⁶¹	Sri Lanka,outpatient department of hospital	88 cases and 80 controls, cases had leg/foot ulcers larger than 2.5 cm²Controls were people with diabetes without ulcers49% cases, 25% controls with income less than Sri Lankan rupee 15,000	Cases: 75% slippers, 16% sandals, 9.2% covered shoes Controls: 55% slippers, 24% covered shoes, 21% sandals
Sukthomya et al. 2021⁶²	Thailand,7 hospitals	N=539, all at moderate to high risk of DFU68% with income less than 10,000 Baht66% had loss of sensation78% visited foot clinic in the previous 6 months21% had chronic ulcer	Inside: 47% barefoot, 39% slippers or flip-flops, 6.1% closed shoes, 5.4% clog shoes, 3.2% sandals Outside: 0.7% barefoot, 43% slippers or flip-flops, 25% closed shoes, 18% clog shoes, 13% sandals
Sundram et al. 2018⁵³	Malaysia,3 hospital outpatient clinics	N=174, 39% had previous DFU28% had active DFU	38% open sandals without back support 13% open sandals with forking 13% closed shoes without laces or adjustable straps 13% closed shoes with laces or adjustable straps 8.6% open sandals with back support 8.6% high-heel shoes 1.7% orthotic or custom-made shoes 3.4% other
Tagang et al. 2014⁶³	Nigeria,multiple hospitals	N=156, not stated	Females: 53% slippers, 19% sandals, 15% half-shoes, 13% shoes, 0% custom-molded shoes Males: 37% slippers, 29% sandals, 17% shoes, 14% half-shoes, 1.9% sports shoes, 1.3% boots, 0% custom-molded shoes
Tagang et al. 2016⁶⁴	Nigeria,not stated	N=156, all had previous DFU	Females: 45% slippers, 24% sandals, 18% half-shoes, 11% shoes, 1.3% sports shoes, 1.3% custom-molded shoes Males: 35% sandals, 26% slippers, 17% half-shoes, 15% shoes, 5.1% boots, 1.3% sports shoes, 1.3% custom-molded shoes
Taksande et al. 2017⁵⁰	India,rural hospital	N=200, patients without diabetic foot, amputated food, or foot ulcersNone did daily foot self-inspection3.0% had previous foot exam by physician	85% chappals

Abbreviations: DFU, diabetic foot ulcer; MCR, microcellular rubber.