635-P: Therapeutic Footwear Is the Main Way to Prevent Foot Ulcer Relapse, but Is Insufficiently Respected

Therapeutic footwear (TFW) is essential to prevent diabetic foot ulcer (DFU) relapse after healing. Our retrospective study aimed at investigating patient’s compliance with TFW 1 year after complete healing, and whether the respect of this TFW in real life conditions was associated with a decrease of DFU recurrence during a 1-year follow-up. This is a retrospective study in which all consecutive patients attending our ambulatory foot unit between 01.2015 and 01.2016, were included if they had a TFW prescription after complete healing. The primary study endpoint was the percentage of compliant patients, who wear the TFW at 1 year. The proportion of patient with DFU relapse was compared in compliant versus non-compliant patients (secondary endpoint). The use of TFW was assessed by analyzing the points of wear and cleanliness of the shoes by the same podiatrist. We included 117 consecutive patients: age 63 ± 13 years, women 29/117 (24,7%), type 2 diabetes: 108/117 (92%), diabetes duration: 17.5 ± 12.5 years. After 12 months, 28/117 patients (24%) were lost of follow-up. TFW was respected in 60/117 cases (51.2%). None of these factors influenced the TFW compliance: sex, age, type of diabetes, diabetic treatment, diabetic duration or complications, HbA1c level, peripheral artery disease, neuropathy, amputations, ulcer localization, healing time, TFW type nor the lack of social insurance. DFU recurrence was observed in 24/89 cases (27%) and was significantly higher in non-compliant patients: 16/29 (55%) vs. 8/60 (13.3%) (P=0.05). The only factor predictive of DFU relapse was non-compliance for TFW. After complete DFU healing, TFW prescription is respected only by half of the patients at 1 year. Non-compliant patients are at higher risk of DFU. Further surveys need to be designed to determine the reasons of non-compliance and to conceive more adapted educational programs.