What are the recommendations for a 70-year-old male patient with no amputations or open wounds requesting medical shoes for foot assessment?

Medical Footwear Recommendations for a 70-Year-Old Male Patient

For a 70-year-old male patient with no amputations or open wounds, medical shoes are only indicated if the patient has risk factors such as peripheral neuropathy, foot deformities, or history of foot ulceration; otherwise, well-fitted walking or athletic shoes that cushion the feet and redistribute pressure are adequate. 1

Assessment Before Recommending Footwear

A thorough foot examination should be performed to determine the appropriate footwear recommendation:

1. Neurological Assessment 1

   • 10-g monofilament testing (essential)
   • At least one additional test: pinprick sensation, temperature perception, vibration testing with 128-Hz tuning fork, or ankle reflex assessment
   • Loss of protective sensation (LOPS) is confirmed by absent monofilament sensation plus one other abnormal test

2. Vascular Assessment 1

   • Inspection of skin integrity
   • Assessment of pedal pulses (dorsalis pedis and posterior tibial)
   • Capillary refill time
   • Signs of rubor on dependency or pallor on elevation

3. Structural Assessment 1

   • Foot deformities (hammertoes, bunions, prominent metatarsal heads)
   • Presence of calluses (indicator of increased pressure)
   • Charcot foot deformities

Footwear Recommendations Based on Risk Assessment

Low Risk (No Peripheral Neuropathy)

• Well-fitted walking shoes or athletic shoes are sufficient 1
• Patient can select off-the-shelf footwear independently 1
• Annual foot examination is recommended 1

Moderate Risk (Peripheral Neuropathy without Deformities)

• Athletic shoes with cushioning properties
• Shoes should be 1-2 cm longer than the foot 1
• Internal width should equal the width at the metatarsal phalangeal joints 1
• Examination every 6 months 1

High Risk (Neuropathy with Deformities or PAD)

• Extra wide or deep shoes 1
• Consider referral for specialized footwear assessment 1
• May need custom insoles or orthoses 1
• Examination every 3-6 months 1

Very High Risk (Previous Ulceration or Amputation)

• Custom-molded shoes may be required 1
• Professional fitting is essential 1
• Examination every 1-3 months 1

Proper Shoe Characteristics

The appropriate medical shoes should have:

• Adequate width and rounded toe box 2
• Flexible flat soles with heel support 2
• Height that allows enough room for toes 1
• Adjustable features to accommodate any dressings if needed 2
• Proper fit evaluated with patient standing, preferably at the end of the day 1

Patient Education

Provide the following instructions to the patient:

• Daily foot inspection, including between toes 1
• Regular washing with careful drying, especially between toes 1
• Avoid barefoot walking indoors or outdoors 1
• Daily inspection of the inside of shoes 1
• Avoid tight shoes or shoes with rough edges and uneven seams 1
• Use lubricating creams for dry skin, but not between toes 1

Common Pitfalls to Avoid

1. Overlooking neuropathy assessment: Many patients with diabetic neuropathy may be asymptomatic despite significant loss of protective sensation 1

2. Inadequate footwear assessment: Ill-fitting shoes are a major cause of ulceration, even in patients with ischemic ulcers 1

3. Focusing only on current wounds: Prevention through proper footwear is critical even in patients without current wounds 1

4. Neglecting patient education: Proper footwear is ineffective without appropriate education on foot care 1

5. Inappropriate shoe modifications: Modifications should be based on specific foot problems rather than general recommendations 3

The evidence strongly supports that proper footwear selection based on risk assessment is essential for preventing foot complications in older adults. Regular foot examinations and appropriate footwear can significantly reduce the risk of foot ulcers and subsequent complications.