Diabetic ulcer alert: Time to rethink our approach to patient adherence

Efforts to prevent diabetic foot ulceration (DFU) are undermined by a disconcerting paradox; people with diabetes and diabetic foot complications are advised to avoid wearing inappropriate footwear which can severely injure their feet, but they still keep wearing them anyway.1 The current consensus is that this paradox can be resolved through effective education.2 Even though the importance of patient education is undisputed, in this opinion piece, we argue that this is not enough and that clinical research and interventions beyond patient education are urgently needed. Drawing insights from the domain of obesity prevention,3 we propose that adjustments to the environment in which individuals with diabetes select their footwear should be also considered. A possible method to achieve this, is by empowering the people who sell footwear to become part of the solution.