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Study on Evolving Medicated Footwear for Diabetic Patients

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Chapter I

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

1.1 Introduction
Foot is the important part of the body. If someone has diabetes he/she is more likely to have to foot problems. Diabetes can damage your nerves. This, in turn, may make you less able to feel an injury or pressure on the skin of your foot. You may not notice a foot injury until severe damage or infection develops. This may led to gangrene in the through simple injuries eventually amputation will be the final choice. So a diabetes patient always has to wear specialized footwear that can protect the foot in more sophisticated way.
Diabetes changes your body's ability to fight infections. Damage to blood vessels causes because of diabetes results in less blood and oxygen getting to your feet.
Because of this, small sores or breaks in the skin may become deeper skin ulcers.
The affected limb may need to be amputated when these skin ulcers do not improve, get larger, or go deeper into the skin.
Worldwide, 50% of all leg amputations happen to people living with diabetes. In
India, an estimated 50,000 amputations are carried out every year due to diabetes related foot problems. By employing reconstructive and corrective footwear, to remove the high pressure points, a large number of such amputations can be prevented. Thus the patient can lead a near normal life, free from complications.
WHO predicts that developing countries will bear the brunt of diabetes epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle income countries.


An estimated 285 million people, corresponding to 6.4% of the world's adult population, will live with diabetes in 2010. The number is expected to grow to 438 million by 2030, corresponding to 7.8% of the adult population. 

While the global prevalence of diabetes is 6.4%, the prevalence varies from
10.2% in the Western Pacific to 3.8% in the African region. However, the
African region is expected to experience the highest increase.
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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter



70% of the current cases of diabetes occur in low- and middle income countries. With an estimated 50.8 million people living with diabetes,
India has the world's largest diabetes population, followed by China with
43.2 million.



The largest age group currently affected by diabetes is between 40-59 years. By 2030 this “record” is expected to move to the 60-79 age groups with some 196 million cases.



Diabetes is one of the major causes of premature illness and death worldwide. Non-communicable diseases including diabetes account for
60% of all deaths worldwide

At the beginning of this century, some statistical research shows that, in
Bangladesh, 1.5% to 2.0% of the whole population is diabetic. That means over 30 lac people is diabetes patient. It means over 60 lac feet are in danger and needs special care.
The most dangerous news is, most of them don’t even know that they are diabetic. So when perfect diabetes footwear will launch in the market it will help to increase the consciousness among the people as well as it will help them to keep their leg safe so as to control diabetes.
Diabetes is not too easy to keep under control. It demands helpful surroundings for the patients to keep it under control. Therefore, a pair of diabetes friendly footwear would an added advantage.
The project work on “Study on evolving medicated footwear for Diabetes
Patients” is enriched about various information of diabetes footwear, characteristics of diabetes footwear, material used for diabetes footwear, manufacturing techniques and the test those are essential for diabetes footwear.
This project work will be helpful for those who think about the safety of diabetes holder’s feet and also will be beneficial for the manufacture of Diabetes Footwear.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

1.2 Overview: Why I was getting interested in doing my project work on Diabetes Footwear:
Diabetes is not too easy to keep under control. It demands helpful surroundings for the patients to keep it under control. Therefore, a pair of diabetes friendly footwear would an added advantage.
Diabetic shoes may cost more than normal shoes, but they are worth it. One of the most dreaded side-effects of diabetes is amputation of the lower extremities, due to gangrenous ulcers of the feet and lower legs. Moreover diabetes footwear can helps in body cooling and reduce the hot damp atmosphere that may cause the development of fungus and bacteria.
Diabetic foot problems arise from poor circulation that causes hyposensitivity
(lack of feeling). Clinical studies have shown that footwear and doctor prescribed orthotics play an important role in diabetic foot care
An internal observation shows that;
A good pair of diabetic shoes should have plenty of room inside – i.e. they will be
‘comfort fit’ rather than ‘tight’. Be especially careful that your shoes have enough room around the toes and ball of the foot. However they must not be too loose either. On the other hand, overly loose fitting shoes can slip and chafe, causing blisters and friction burns, which greatly increase the risk of skin infection in a diabetic patient.
Taking this into account some shoe companies sell ‘regular’ shoes as the diabetes shoe adding just some extra room. We agree that these shoes are fairly wellsuited for diabetics but not complete footwear for diabetes and they can’t meet the special demands.
Shoes designed for people who stand on their feet all day (such as nurse’s shoes) often used for diabetics for the meet most of the requirements for diabetic shoes.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Other “natural” shoe companies design their shoes with roomy, contoured toe areas, and orthopedically “correct” foot beds. Many of their shoe designs often
‘converted’ to acceptable diabetic shoes with the simple addition of extra insole padding. The above mentioned cases induced us to pay some concentration on developing a complete pair of diabetes footwear that is designed perfectly aiming the diabetes patient.
People with a history of diabetes and foot ulcers needed several styles of safe and attractive shoes for regular activities. It’s proven from several studies; for instance some of the studies are quoted below.
M.V.Hospital, Royapuram, while opening their newly launched foot department released a brushier where they end up with under quoted conclusion:
“The quality of foot care needs much improvement. The poor knowledge of foot care among the diabetic patients, lack of proper foot care teams, delayed referral of patients with foot infections to specialists are some of the factors responsible for the poor quality of foot care at present. Education of patients, health care professionals regarding diabetic foot care and specialized footwear is an urgent priority in order to reduce the number of amputations.”

In Bangladesh; Birdem have 4 lac 50 thousand registered patient and assumed that over 7 lac registered patient is taking the treatment in various health care centre all over Bangladesh.
1.2.1 Statistical overview of prevalence of diabetes among the Bangladeshi’s

(Source: Parveen Akter Khanam, research division, Birdem)
Prevalence of Diabetes Mellitus (DM) in the year 2009
Country
Bangladesh

Population
(20 to 79 years) 2009

80583.700

DM prevalence 6.3%
5076.77

No. of people with DM (000’s)
Urban
2526.49

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Rural
2514.66

Male
2980.16

Female
2061.03

Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

According to more specified age group (in the year 2009)
Country
Bangladesh
2009

Population
(20 to 79 years) 80583.700

Age group
20 to 39
2526.49

40 to 59
2514.66

60 to 79
2980.16

Projected Prevalence of Diabetes Mellitus (DM) by 2025
Country
Population
Bangladesh (20 to 79 years) 2025

120920.910

DM prevalence No. of people with DM (000’s)

12.5%
15115.114

Urban
9792.39

Rural
5338.27

Male
Female
8900.28 6230.38

According to more specified age group (by 2025)
Country
Bangladesh
2025

Population
(20 to 79 years) 120920.910

Age group
20 to 39
5339.9

40 to 59
7619.10

60 to 79
2171.60

Prevalence estimates of Impaired Glucose Tolerance (IGT) in the year 2009
Country
Bangladesh
2009

Population
(20 to 79 years) 80583.700

IGT prevalence 10.6%
8546.40

No. of people with IGT (000’s)
Urban
1310.60

Rural
7235.80

Male
4440.90

Female
4105.50

According to more specified age group (in the year 2009)
Country
Bangladesh
2009

Population
(20 to 79 years) 80583.700

Age group
20 to 39
4390.50

40 to 59
2767.50

60 to 79
1389.80

Projected prevalence estimates of Impaired Glucose Tolerance (IGT) BY 2025
Country
Bangladesh
2025

Population
(20 to 79 years) 120920.910

IGT prevalence 10441.95

No. of people with IGT (000’s)
Urban
2666.04

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Rural
7775.91

Male
5080.29

Female
5361.66

Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

According to more specified age group (by 2025)
Country
Bangladesh
2025

Population
(20 to 79 years) 120920.910

Age group
20 to 39
5147.00

40 to 59
3609.20

60 to 79
1688.40

In a study by Uccioli, it was shown that customized footwear was beneficial for patients with previous foot ulceration and for those considered at high risk of foot ulceration. Re-ulceration occurred in 58% of patients who resumed wearing their own footwear, compared with 28% of those who wore therapeutic footwear.
However, patients with foot deformity, such as charcot joint, were not included in this study.
The prevalence and severity of foot deformities and ulceration in diabetic subjects who had had a great toe amputation was studied by Quebedeaux. They found that because of altered pressure distribution, the foot with great toe amputation developed more frequent and more severe deformities of the lesser toes and metatarsophalangeal joints compared with the other intact foot. Because these patients were at high risk for subsequent ulceration, the use of special footwear to protect the feet was highly recommended.
The effect of therapeutic footwear in ischemic or neuropathic ulcers was studied in 239 patients by Edmonds; the re-ulceration rates were 26% among the therapeutic footwear group and 83% among those who wore their own footwear.
The benefits of therapeutic footwear are well known. In a study by LeMaster, it was shown that education by mailed motivation brochures improved the awareness and increased the number of people making therapeutic footwear claims. This study underscores the benefits of footwear education regarding therapeutic footwear use.
An observation carried out by University of Washington, Seattle, WA and Joslin
Diabetes Center at Swedish Medical Center, Seattle, WA show that; people with prior foot ulcers indicated they need a variety in shoe types and styles. These
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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

individuals should be encouraged to use adequate footwear and minimize the time spent in dangerous footwear, stockings, and going barefoot. The combination of good foot care and adequate, acceptable, and reasonably priced footwear is important to ensure healthy feet in high-risk people with diabetes.
The footwear also has an enormous market potential. In one sentence we can express, diabetes is the lifelong enemy of the patient and diabetes footwear would be the lifelong friend of the patient.

1.3 Aim of my project work:
1. Designing and Construction of medicated shoes for the diabetic holder. 2. Market demand of diabetes footwear.
3. Learning about the materials used for making diabetic footwear.
4. Learning about various safety features that has to be incorporated in footwear for diabetic holder.
5. Learning about the prevalence of diabetic holders in Bangladesh.
6. To learn the about foot problems related to diabetic and their curing.
7. Effect of shoes on diabetes holder.
8. Diabetic holder’s foot care.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

1.4 Review of the entire process of Methodology:

Methods Flow Chart

Identify the project objective

Research all relevant area for your design approach

Brainstorm for a variety of possibilities

Conduct user surveys to gather personal opinions Apply these steps to your design approach

Table 1 Methods Flow Chart

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Chapter II

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

2.1 Origin of Footwear
From which the term “shoe” is originated: In English, the term “shoe” dates back to many centuries beginning with the Anglo-Saxon. “Sceo” meaning a foot covering and evolving into “Schewis”, then “Schooys” and finally “shoe”. The
German “Schuh” has the name origin. Through the centuries the word “shoe” has evolved with at least 17 different spelling and some 36 variations of the plural.

2.2 Definition of Footwear:
Any foot covering in the form of shoes, boots, slippers are used for utility and dress wear. Any form of footwear made of various kinds of materials or combination of materials like leather, canvas, rubber, textiles, wood and synthetics to protect the foot from cold, heat, thorns, hazards etc. and to serve as a costume in the form of sandal, shoe or boot. These shall include walking shoes, dress shoes, occasional footwear, sports footwear, occupational footwear, orthopedic and surgical footwear meant for the use of babies, children, ladies or gents.

2.3 History of Shoes

Fig 2
Fig 2
Fig 1 : Sandal made of
Papyrus Fiber

Fig 3

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

2.4 PURPOSE OF FOOTWEAR
The shoe has two primary functions to perform and has acquired through the years other lesser ones.
The primary functions are:
a) To protect the sole of the foot from the heat, cold, dampness, dirt or roughness of the ground in walking and standing.
b) To the upper part of the foot, and if required, the leg, from cold, rain, thorns, heat and insect or other bites.
Lesser functions are:
c) To assist the foot to perform some abnormal task. This includes the various sports such as football, cricket, hockey, running, fishing, riding, mountaineering, dancing, etc. all of which today have their own special footwear. So, also, have many trades, such as mining, deep-sea diving, munitions manufacture and fire-fighting, and the armed services.
d) To complete a costume. This is particularly important today when costume designing includes not only the dress but also the hat, shoes. Gloves and handbag. In fact, the main purpose of the shoe may be to complete or enhance the remainder of the costume, the primary functions of footcovering and sole-protection being subordinate to this.
e) To indicate rank or office. This is not applicable in western civilizations, unless we include the notorious “jackboot” in this category, but formerly it was important, certain types of shoe being restricted to certain classes; there is obviously a very close link here with the purpose stated in above Para.
f) To overcome abnormalities in the foot itself, the surgical boot being the extreme example of this, while many shoes incorporate corrective devices, some more corrective in name than in fact.
g) To fulfill the fashion. In some cases, the protecting purpose becomes trivial and here the main purpose is to meet the fashion demand.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

2.5

Different types of Footwear

2.5.1 DERBY:
 Most commonly used formal and casual shoes.
 A very wide range of styles can be
Derived from a derby design
 Unisex
 Can be identified from the following points:
 Lock stitch or stay stitch

Fig 5: Derby

 The quarter can be opened till half of the tread line.
 The vamp and tongue will be on the same line.
 In most of the cases quarter will be on the vamp.
2.5.2 OXFORD:
 Most widely used as formal shoes.
 Unisex
 Quarter is locked at the vamp point and hence opening of the quarter is limited.
 Has an independent tongue which is stitched at the final stage of the upper.

Fig 6: Oxford

 In most of the case vamp will be on the quarter.
2.5.4 SANDALS:
 A popular unisex footwear which is very comfortable
 The foot is free at the toe and heel
 The sandals serves according to the specific needs as the length can be adjusted with the help of buckle.

Fig 7: Sandals

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

2.5.5 SLIP ON:

 Slip on is also called as pantafola & loafer.
 As the name indicates these shoes can be slipped in and slipped out very easily.
 Does not have lace.
 Can be with or without elastic
 Saddle is present in most of these designs.

Fig 8: Slip on

2.5.6 BOOT:
 Casual shoes popular among kids and Teenagers
 Different types of boots are Ankle Boot,
High boot, Knee boot & Thigh boot.
Fig 9: Ankle Boot

2.5.7 MOCCASIN:
 The most comfortable shoe to wear
 Expensive as more leather is consumed
 Formal & casual shoe
 Bottom will be covered with upper leather at the fore part
 Hand stitching gives a good appearance.

Fig 10: Moccasin

2.6 Anatomy of the shoe
According to McPhoil (1988) the anatomy of a shoe can be divided in an upper and lower (or bottom part). Sections of the upper include vamp, quarter, toecap, throat, insole board, and top line. The sections of the lower shoe consist of an outsole, shank and heel.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Fig 11: parts of shoe

2.7 Parts of the Shoe
All parts or sections of the shoe above the sole that are stitched or otherwise joined together to become a unit then attached to the insole and outsole. The upper of the shoe consists of the vamp or front of the shoe, the quarter i.e. the sides and back of the shoe, and the linings.
Vamp
The vamp covers the dorsum of the foot (includes the tongue piece) and superior aspects over the toes. This section i.e. the toe puff is reinforced which serves to give the shoe its shape as well as protect the toes.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Quarter
The complete upper part of the shoe behind the vamp line covering the sides and back part. The top edge of the sides and back of the quarter describes the top line of the shoe. In athletic shoes the top line is often padded and referred to as a collar.
The medial and lateral sections join in a seam at the posterior end of the shoe.
Toecap
Many shoes incorporate a toecap into the upper of the shoe. Toecaps are either stitched over or completely replace the distal superior aspect of the vamp and can be made into a decorative features referred to as toe tips. The toe box refers to the roofed area over and around the part of the shoe that covers the toes.
Linings
In quality shoes the quarters and vamps are lined to enhance comfort and durability. Linings may consist of various materials i.e. leathers, fabrics, and manmade synthetics.
Throat
The central part of the vamp just proximal to the toe box. The throat is formed by the seam joining the vamp to the quarter i.e. throat line. The position of the throat line depends on the construction of the shoe, for example a shorter vamp and longer quarters define a lower throat line.
The Sole of the Shoe
The term sole derives from 'solea' a Latin word meaning soil or ground.
Insole (inner sole)
A layer of material shaped to the bottom of the last and sandwiched between the outsole (or midsole) and the sole of the foot inside the shoe. The insole covers the join between the upper and the sole in most methods of construction and provides attachment for the upper, toe box linings and welting.
Outsole
This is the outer most sole of the shoe, which is directly exposed to abrasion and wear. Traditionally made from a variety of materials, the outsole is constructed in different thickness and degrees of flexibility. Ideal soling materials must be waterproof, durable and possess a coefficient of friction high enough to prevent slipping. Page 16 of 85

Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Shank
The shank bridges between the heel breast and the ball treed. The shankpiece or shank spring can be made from wood, metal, fiberglass or plastic and consists of a piece approximately 10cm long and 1.5 cm wide. The shank spring lies within the bridge or waist of the shoe, i.e. between heel and ball corresponding to the medial and lateral arches.
Heel
The heel is the raised component under the rear of the shoe. Heels consist of a variety of shapes, heights, and materials and are made of a series of raised platforms or a hollowed section. The part of the heel next to sole is usually shaped to fit the heel, this is called the heel seat or heel base. The heel breast describes front face of the heel.

Welt
The strip of material which joins the upper to the sole. Most shoes will be bonded by Goodyear-welted construction. Some shoes use an imitation welt stitched around the top flat edge of the sole for decorative purposes, but it is not a functional part of the shoe.
Last
"The close relationship between a man and his shoe maker was based on the shared secret of the client's measurements. The statistics of clients were never disclosed."
Traditionally before mass production, the original shoemaker started the process by taking a footprint outline of the sole. He whittled or chiseled a wooden last from the print. A last (‘laest’, Old English meaning footprint) was traditionally made from wood but are now available now in metal or plastic.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Chapter III

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

3.1 What Are Diabetic Shoes?
Foot care for diabetics is as important as taking care of other organs of the body.
Diabetics are more vulnerable to foot related disorders which eventually can lead to more serious complications. For this reason, diabetics are advised to wear specially designed slippers or shoes to prevent ulcer or blisters on foot.
What are the best shoes for diabetics? This is one question all diabetics come to ask. Cheap diabetics shoes and discount shoes which actually look good are always sought after by diabetics just as they are by any other person going about their lives but when you are living with diabetes you simply can’t afford to wear shoes which do not properly protect your feet.
Shoes which leave your feet exposed at the toe can put you at risk for experiencing damage to your toes without you even realizing it. You could easily stub your toe or kick a small object and not think twice about it due to low sensitivity in your feet but later you may find that the damage you inflicted is bad and possibly exacerbated by the lack of attention after the injury.

3.2 Why Wearing Diabetic Shoes Is So Important?
The simple fact is that people with diabetes tend to have a progressive degeneration in their nerves. Neuropathy of the nerves in the lower extremities in particular can be brought on by many years of poor blood glucose control. When years of high glucose levels in the blood are coupled with high levels of circulating insulin in the blood stream nerves slowly can become damaged and can eventually lose all sensitivity which can make it very easy for you to hurt yourself without even realizing it.
Additionally living with diabetes for years on end can cause a slow deterioration in the small blood vessels and capillaries at the ends of your feet and toes making the healing process very slow when damage occurs. Because your ability to heal is compromised the protection of the feet becomes that much more imperative.
Obviously we can see why proper diabetic foot care is so important. If we are more prone to hurting our self because we can’t feel pain in your toes, feet, ankles, or
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lower legs and you are less able to heal in those areas then you can see that people with diabetes will often have many problems with their feet, some of which are irreparable resulting in wounds, infection, and eventual amputation.

3.3 What Makes a Good Shoe for Diabetes
Shoes for diabetes patients are characterized in general as being wide, roomy, soft, and supportive. They should be a size larger than the actual fit, with broad toe box, a hard outer sole, a firm cup heel to prevent the heel from spreading, with retaining straps or laces and smooth insides.
Every person will have different needs and some people will have such extreme cases that no diabetic shoe on the market will be good for them. When major foot deformities occur resulting in feet which are extremely malformed a podiatrist will likely have to prescribe medical diabetic shoes or prescription shoes for diabetes.
These shoes will generally exhibit the classic diabetic shoe design but will be shaped more specifically for your foot and may have a molded insert designed to distribute weight and pressure evenly around the foot.
Standard shoes for diabetics will not be as intensely made and they won’t cost as much either but they will be made of soft materials and leathers which are less likely to rub and cause irritation or foot ulcers. They are almost always going to be laced and snug so as to lower the amount of irritation a loose shoe can inflict. For instance a sandal or loafer will always be loose and will have defined areas where rubbing and irritation can occur. Diabetic shoes will not have these areas.
Similar to the therapeutic diabetes shoe, shoes designed for diabetics will usually be wider than normal through the middle of the shoe and especially at the end near the toes. This is to accommodate the often large feet, toes, and other deformities that many diabetic sufferers have. Normal diabetic shoes will almost always be a little longer than standard shoes so that toes are less likely to extend and touch the end of the shoe. Basically anything that ensures that pressure points and irritation spots are minimized are main characteristics of diabetic footwear.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

3.4 Which Diabetic Shoes Should We Buy
Ideally you will buy a pair of diabetes shoes for all the activities you do. You really shouldn’t be wearing standard shoes at all. If you are in early stage diabetes you may be able to get away with it but if you treat the condition with respect you will do whatever you can to manage the condition better and that means wearing the right type of shoes for all occasions.
The common tips for diabetes footwear may be;
 Shoes should be merely protective for diabetes feet from injury. Otherwise, if the patient have poor vision and less ability to feel pain, he/ she may not notice minor cuts or bumps;
 The footwear should be comfortable, well-fitting that have plenty of room in them; footwear should consist of well fitting technique subjected to patient, hoping the shoes will stretch with time. Nerve damage may prevent the patient from being able to sense pressure from improperly fitting shoes.
 Shoes should be made out of canvas, leather, or suede. It should not be made out of plastic, or another material that does not breathe.
 The footwear should have adjustable fastening system. They should have laces, Velcro, or buckles.
 Footwear should not accumulate with pointed or open toes, such as high heels, flip-flops, or sandals.
3.4.1 Other Things to Consider
Size differences. Don't choose shoes by the size marked inside. Go by how they feel on your feet. Even though you measure your feet, sizes can vary by style, shoe brand, company and the country that makes the shoes. Make sure your shoes have enough room in the toe area, over the instep, and across the balls of your feet. The shoes should also fit snugly around your heels.
Width and length. Width is just as important as length when it comes to shoe size. The proper shoe size is the one where the widest part of the foot, the base of the toes, is in the widest part of the shoe. There should also be a 3/8-inch to 1/2inch space between the end of the shoe and the longest toe.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Lacing up. Shoes with laces let you adjust your fit if swelling or other conditions that change the shape of your feet occur. Laces can also keep your shoes from slipping off.
If you are in the early stages of diabetes and have no history of foot problems or any loss of feeling in your feet, a properly fitting shoe made of soft materials with a shock-absorbing sole may be all you need.
Pedorthists. If you have numbness in your feet (neuropathy), a history of foot ulcers, or any changes in your foot structure, you should be fitted by a boardcertified pedorthist. A pedorthist is someone who is trained in the assessment, design, manufacture, fit and modification of foot appliances and footwear. People who lose feeling in their feet tend to buy shoes that are too tight. The size that
"feels" right is often too small and the shoes may end up causing problems.
The major brands of shoes which make wide shoes or diabetic shoes such as
Propet, P.W. Minor, and Drew Shoes, as well as many others, make different kind of shoes designed for different kinds of activities. You can find diabetics athletic shoes, diabetic walking shoes, diabetic dress shoes for men and women.
High heels are probably not going to be a good option nor are sandals or loafers but diabetic house shoes and work shoes including heavy duty work boots can easily be found. Make sure to look at all the shoes the major diabetic shoe companies offer and buy a pair for all the activities that are important to you… and yes you should buy some shoes for walking as you need to stay active – this is one of the best ways to help manage diabetes. Many walking shoes are good for all kinds of activities but one of the best shoes for diabetics for general all purpose wear are the casual line of diabetic shoes by Propet. If you are new to the world of diabetic support shoes then acquaint yourself with this brand. You may just find the shoe for you.

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3.5 The Best Diabetic Slippers
Diabetics often experience foot-related disorders that affect their quality of their life and eventually cause more severe medical complications. This is why diabetics are highly recommended to wear special shoes such as diabetic slippers, both indoors and outdoors. They are specially designed to reduce the possibility of the development of both ulcers and blisters. If these wounds are not given the attention that they need, they can potentially lead to serious infections, or even amputation. This makes it clear why choosing the right pair of diabetic slippers is an important task. The purpose of this article is to help you do just that.
The first thing that you should do is visit the podiatrist. Since no two pairs of feet are exactly the same, the podiatrist can help determine whether or not your feet have any irregularities that need to be taken into account or require special care in order to maintain good health. He will also be able to provide you with additional guidance as to what sort of diabetic slipper, socks, and shoes you may need.
Medicare, as well as most health insurance plans, should cover the cost of one pair of shoes for diabetics, as well as three sets of orthotic inserts each year. If you are still confused, your doctor will be able to provide you with additional guidance.
Once you are aware of your feet’s particular needs, you may start looking for your special slippers. Comfort and support are the key features you should be seeking, but there are several other details you have to consider. Diabetic shoes and slippers are generally deeper than the regular footwear, as the custom insoles mush fit inside them without making your feet feel uncomfortable. Orthotic inserts are an important part of diabetic foot care, but they have to be used correctly.
Ventilation is another important factor to be considered. If a diabetic slipper is not breathable, the moisture and the heat inside it will make a perfect breeding ground for bacteria. Moreover, look for seamless and lightweight constructed slippers to prevent irritation. Proper arch support will be very helpful in the weight distribution and in alleviating pain in the pressure points.
Make sure the slippers provide enough room for your toes. This type of footwear comes in a wide range of widths, so you should not have any issues in finding a pair
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of wide diabetic slippers that perfectly accommodates your feet. The slipper’s width should properly match the ball of your foot while the toe box of the shoe has to be high and sturdy to minimize the discomfort.
Speaking of the toes, diabetic slippers should also wrap around the foot with a soft form or fabric rather than having straps between the toes. These straps could eventually lead to the breakdown of skin and the development of ulcers due to the constant rubbing between the toes.
The heel of the slipper has to fit perfectly as well. It should not be tight, but snug, so that the constant rubbing will not feel uncomfortable. In addition to providing a measure of shock absorption, the thick soles common to diabetic slippers will also help to provide stability.
The final consideration, whether you are choosing women’s or men’s diabetic slippers is the style. While you will certainly be much more limited that you would be if you were searching for regular footwear, there is still a bit of variety that you can choose from. Choose a pair that suits your preferences and personality.

Fig 12: Sheepskin Diabetic Slippers

3.6 Diabetic Socks
After picking your diabetic slippers, you should also get the right accessories. Stock up on at least three sets of customized orthotic insoles and several pairs of seamless diabetic socks. These particular kinds of socks help to prevent moisture buildup, and are loose at the top so as to not inhibit circulation. Compression socks may also be a good idea if you have circulation problems, but talk to your doctor before using them in order to ensure that they will not cause any problems.
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Now that we know why diabetic socks are important to the continued good health of a diabetic, how exactly do you go about choosing which pair is right for you? Due to the dangers of diabetic peripheral neuropathy, a condition in which the feet become numb due to the nerves of the feet being damaged, there are a few features that you are going to specifically keep in mind when you are shopping for a new pair of diabetic socks.
3.6.1 Cotton Diabetic Socks Help Control Moisture
One feature in particular that is very important when it comes to socks for diabetics is the careful control of moisture levels. Since diabetics are so much more prone to developing infections than the general population, it is important to do everything that you can in order to prevent creating an environment conducive to fungal and bacterial growth. The best diabetic socks will also feature antimicrobial properties.
An example of this can be found in the case of Aetrex diabetic socks, which include bits of copper that are woven into the soles and material in order to help prevent microbial growth. You will want to choose socks that contain a good deal of natural fibers, such as cotton diabetic socks, as the natural fibers will allow your feet to
“breathe,” and help to prevent moisture buildup against the feet.
Moisture control is also important because moisture increases the amount of friction that your feet will experience inside the socks. Diabetics tend to suffer from not only peripheral neuropathy, but also tend to have bad circulation, particularly in their feet. This renders the skin of the feet susceptible to injury which you may not even notice because of the numbness. In order to prevent the injury and breakdown of the skin, seamless diabetic socks can be useful because your feet will not have to run against that inside seam as you walk or otherwise move around.

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Fig 13: Diabetic Socks for Men

3.6.2 Compression Hosiery
Diabetic socks should also provide adequate compression to the leg in order to support the blood vessels and to help circulate blood any lymphatic fluids back into the body. Diabetic compression socks apply firm compression to the leg, usually in the range of 20 – 30 mm/Hg, with the highest compression at the ankle and the lowest at the top of the sock in order to help support good circulation. This will help slow the progression of neuropathy and development of other diabetic foot problems. There are quite a few different varieties of diabetic sock available in the marketplace. This is due to the wide range of foot problems that tend to befall diabetics, which can eventually lead to very severe consequences. Every year, about
70% of foot and leg amputations occur in patients who are suffering from diabetes.
If you take the time to take care of your feet, which involves a regimen of care, exercise, sanitation, and protection through diabetic socks and other specialized footwear such as diabetic slippers, you will be able to avoid becoming part of that statistic. For sufferers of varicose veins and poor blood circulation, the pain assigned with this condition can be unbearable. The lack of blood flow can cause cramping, fatigue, and numbness shortly after walking or running. Although elevating the legs is a temporary relief, it is only a quick fix. These circulation problems can be not only uncomfortable, but cause a man or woman to not lead a healthy and active life. Medical compression socks are physician approved and a great alternative to surgical procedures.
The compression sock is a specialized piece of hosiery that is designed to provide the legs and foot extra support while stimulating increased blood circulation for
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those who sport this effective compression hosiery. Although these compression socks look similar to traditional knee high dress socks, they are actually specially designed to ensure good health by functioning as medical therapeutic leg wear.
Men compression socks and women’s compression socks alike, offers a graduated pressure application. Unlike traditional socks, the compression sock is designed of stronger elastic materials such as rubber, spandex and Lycra. These materials assist the compression process in creating significant pressure on the surface veins, muscles and arteries that force blood in motion. The pressure causes the blood to flow back to the heart and eliminates blood pooling at the feet that is what causes the pain and numbing affect. Support socks are tighter at the ankles, and are less constricting as it moves upward in knee high compression socks.
While this specialized hosiery was originally invented to ensure the good health of sufferers of circulatory problems, everyday people have found these socks to be not only beneficial but also comfortable. It is recommended to wear these socks during long flights due to the compression changes in the planes cabin during flight. These socks have also become popular among athletes, who have found that they make their muscles more efficient during long distance cross-country and marathons.
There has been an increase of medical leg wear manufacturers hitting the market since the increase in popularity in the early 1970′s. Dr. Scholls has released an over the calf compression sock available in black and sizes small through extra large.
Another medical compression sock known worldwide for their quality hosiery is
Jobst Medical Leg Wear. Either of these will have something to offer for those with medical problems or athletes.
So no matter the need for supportive leg wear, there are affordable options on the market for you to live a happy, healthy and active lifestyle.

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Chapter IV

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4.1 FOOT ANATOMY
It is important to have some knowledge and understand the anatomy of the foot and how the foot functions to design a shoe.
Scholl (1946) states the following:
The bones of the foot are divided into three sections known a Tarsus, Metatarsus, and Phalanges. The tarsus group of bones consists of the Os Calcis, Astragalus,
Scaphio, Internal Cuneiform, Middle Cuneiform, External Cuneiform and Cuboids, or a total of seven bones. The Metatarsus consists of five metatarsal bones; these bones form the instep and forward or anterior end together with the bones of the toes form the ball of the foot and Anterior Metatarsal Arch. The Phalanges, or the bones of the toes, consist of fourteen bones. There are three bones in each toe except the great toe, which has only two. The largest bone in the foot is the Os
Calcis or heel bone. It is to this bone that the big, heavy tendon Achilles is attached.
The entire weight of the body is carried onto the foot and is suspended by the high point of the arch. The foot is constructed for the purpose of taking the weight of the body, carrying it and doing so comfortably. There is a reason for there being so many bones in the foot.

Figure 14 Foot Anatomy

Figure 15 Foot Anatomy

4.2 COMMON FOOT PROBLEMS:
While designing a specialty shoe with fashion in mind the function of the foot and common foot problems should be researched to get an understanding of what consumers needs are. Some injuries are inheritable, accidental, or some are caused by poorly fitted shoes.
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Figure 16 Bunion
Bunion: A large unsightly bony bump around the big toe joint is called a bunion.
The main cause of a bunion is congenital. Shoes may have very little to do with the formation of a bunion, but can be an aggravating factor. When the big toe joint is deviated with a bunion deformity, the body weight transmission is not as effective.

Figure 17 Flatfoot
Flatfoot: A foot in which the arch of the instep is flattened so that the entire sole of the foot rests upon the ground; also, the deformity, usually congential, exhibited by such a foot; splayfoot. Causes of flatfeet could be congenital, neuromuscular diseases, injury to the foot, ruptured tendon, tight Achilles tendon, arthritis or a small bony bridge between the bones in the foot.

Figure 18 Hammer Toe
Hammer toe: A deformity of the toe in which the toe is bent downward like a claw. A hammer toe occurs when the middle of the toe points upwards abnormally. This most often occurs in the second toe, and is often the result of a big toe bunion pushingon the second toe.

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Figure 19 Flatfoot
Flatfoot: A foot in which the arch of the instep is flattened so that the entire sole of the foot rests upon the ground; also, the deformity, usually congenital, exhibited by such a foot; splayfoot. Causes of flatfeet could be congenital, neuromuscular diseases, injury to the foot, ruptured tendon, tight Achilles tendon, arthritis or a small bony bridge between the bones in the foot.

Figure 20 Arthritis
Arthritis: Arthritis is not one disease, but over 100 known diseases that affect the bones, muscles and joints. The term does not designate a specific disease, but signifies inflammation of a joint resulting from any cause. Pain and swelling can ensue (particularly in the hands and feet), which creates limited movement and mobility. Figure 21 Diabetes
Diabetes: Diabetes is a syndrome in which the basic defect is an absence or shortage of the pancreatic hormone insulin. This deficiency disrupts the vascular system, affecting the eyes, kidneys, legs, and other extremities such as the feet.
Diabetic foot problems arise from poor circulation that causes hyposensitivity (lack of feeling). Clinical studies have shown that footwear and doctor prescribed orthotics play an important role in diabetic foot care.

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4.3 Diabetic Foot
If you have diabetes, your blood sugar levels are too high. Over time, this can damage your nerves or blood vessels. Nerve damage from diabetes can cause you to lose feeling in your feet. You may not feel a cut, a blister or a sore. Foot injuries such as these can cause ulcers and infections. Serious cases may even lead to amputation. Damage to the blood vessels can also mean that your feet do not get enough blood and oxygen. It is harder for your foot to heal, if you do get a sore or infection. You can help avoid foot problems. First, control your blood sugar levels. Good foot hygiene is also crucial.

4.4 How Diabetes and Foot Care Go Hand In Hand
One rationalization that many men have, especially early on in their diabetic lives, is that foot care is not all that important, what’s really important is staying healthy and managing glucose levels better. It’s true that managing your glucose levels is most important but what is lost on many people is that even properly managed glucose and insulin still causes slow degenerative damage to the body.
Diabetes by its very nature is damaging to the body and even when managed effectively it can still be harmful in the long run. The reason proper diabetic foot wear is so important is because the lower legs and feet tend to be one of the main areas which first show signs of damage.

Fig 22: what happens to diabetic feet.

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Basically when you are diagnosed with diabetes your body has begun becoming resistant to insulin. When you eat foods your digestive tract breaks the food down into glucose to circulate through the blood stream to the cells of the body. Your pancreas then secretes insulin, a hormone which helps metabolize the glucose in your blood into your cells so that the glucose can be used for energy.
The problem however is that in insulin resistant people and people with type-2 diabetes, the body’s response to the insulin is sluggish and the glucose levels remain elevated in the blood stream despite an increase in the amount of insulin produced. Eventually the job is done and glucose levels decline but the elevated levels of glucose and insulin in your blood stream slowly causes damage to your body… it is not healthy and The first place to show significant damage in most
People are their feet.
The problem however is that in insulin resistant people and people with type-2 diabetes, the body’s response to the insulin is sluggish and the glucose levels remain elevated in the blood stream despite an increase in the amount of insulin produced. Eventually the job is done and glucose levels decline but the elevated levels of glucose and insulin in your blood stream slowly causes damage to your body… it is not healthy and the first place to show significant damage in most people is their feet.
When diabetes takes its toll on a person’s feet a couple of things begin to happen.
The small blood vessels in the outer extremities begin working poorly. Circulation in the smallest of blood vessels diminishes and healing in these areas of the body slows. While this is happening the early stages of neuropathy in the feet begin developing. This condition basically causes the body to slowly become insensitive to pain or discomfort leading many people to develop ulcers, sores, and even broken toes without ever even realizing they were being damaged.
When pain and sensation tolerances get to this point it becomes very easy for people with diabetes to injure themselves and it becomes increasingly harder for these injuries to heal.

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This is why diabetic foot care is so important and should be considered one of the top priorities of diabetic men and women. They should always check their feet for cuts, bruises, or early wounds so that they don’t get worse and become infected.

Fig 23: checking foot every day

4.5 Practice of Proper Diabetic Foot Care
Wearing the best shoes for diabetics is probably the easiest and most effective way to ensure that your feet are well protected and safe from damage and wounds however you can’t simply rely on expensive shoes to do all the work for you. You also have to make sure you practice all the routine diabetic foot care practices as well. You should be wearing diabetic socks when appropriate, regularly seeing your podiatrist, staying active and healthy, managing your diabetes with your doctor, taking the proper steps to improve insulin resistance, and carefully examining your feet on a regular and frequent basis for wounds, cuts, and bruises that might crop up from time to time.
If you can stay on top of managing your diabetes better and addressing foot problems early before they become serious you can usually stay much more active and live a much higher quality of life. Proper foot care for diabetes isn’t all that complicated but it must be adhered to on a regular and constant basis.

4.5.1 DAILY CARE ROUTINE
 Check your feet every day. Look carefully at the top, sides, soles, heels, and between the toes.
 Wash your feet every day with lukewarm water and mild soap. Strong soaps may damage the skin.

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 Test the temperature of the water with your fingers or elbows before putting your feet in warm or hot water. Because of your diabetes, you may not be able to sense if the water is too hot. Burns can easily occur.
 Gently and thoroughly dry your feet, particularly between your toes.
Infections can develop in moist areas.
 Your feet may become very dry and may crack, possibly causing an infection. After bathing your feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your toes.
Ask your health care provider if it is okay for you to trim your nails. If it is, ask your health care provider to show you the safest way. If your toenails are not trimmed correctly, you may get a foot sore or ulcer.


Soak your feet in lukewarm water to soften your nails before trimming.



Cut the nail straight across, because curved nails are more likely to become ingrown. 

Avoid sitting with legs crossed or standing in one position for long periods of time.



If you smoke, stop. It decreases blood flow to the feet.

4.5.2 TIPS ON SHOES AND SOCKS
Socks may provide an extra layer of protection between your shoe and your foot.


Wear clean dry socks or non-binding panty hose every day.



DO NOT wear stockings with seams that can cause pressure points.

Wear socks to bed if your feet are cold. In cold weather, wear warm socks and limit your exposure to the cold to prevent frostbite. Wear shoes at all times to protect your feet from injury. Otherwise, if you have poor vision and less ability to feel pain, you may not notice minor cuts or bumps.


Check the inside of your shoes for rough areas or torn pieces that can cause irritation.



Change your shoes after 5 hours of wearing them during the day. This changes the pressure points during the course of the day.

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The type of shoes you wear when you have diabetes is important:


Wear comfortable, well-fitting shoes that have plenty of room in them.
Never buy shoes that do not fit properly, hoping the shoes will stretch with time. Nerve damage may prevent you from being able to sense pressure from improperly fitting shoes. You may need a special shoe made to fit your foot.



Wear shoes made out of canvas, leather, or suede. Do not wear shoes made out of plastic, or another material that does not breathe. Do not wear thong sandals.



Wear shoes you can easily adjust. They should have laces, Velcro, or buckles. 

Do not wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.

4.5.3 SOME MORE HELPFUL TIPS



Antiseptic solutions should not be used on your feet because these can burn and injure skin.



Heating pad or hot water bottle should not be used to your feet. Avoid hot pavement or hot sandy beaches.



Remove shoes and socks during visits to your health care provider. This is a reminder that you need a foot exam.



Corns or calluses should not be used by yourself using over-the-counter remedies. Make an appointment with a podiatrist to treat foot problems.



If obesity prevents you from being physically able to inspect your feet, ask a family member, neighbor, or visiting nurse to perform this important check. Page 36 of 85

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Chapter V

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5.1 Role of Diabetes Shoes
A Diabetes shoe is modified to incorporate features designed to replace the missing portions of feet, relieve pressure, shift weight, or permit desired movement of the ankle. The shoes enhance the balance, mobility, and appearance of the patients.
5.2 The Ideal Diabetes Shoe
Diabetes shoes should have the following characteristics:
A) A wide toe box to accommodate toes without pinching them supported by extra firm toe puff.
B) Very soft and flexible instep point.
C) Extra soft top line foam
D) A firm heel counter.
E) Removable molded inner sole
F) Rigid or semi rigid shank
G) High quality shock absorber pu sole.

Fig 24: components of diabetes shoe

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5.3 Other features to consider in good Diabetes shoes include:
 A padded collar and tongue to protect sensitive areas, reduce irritation and secure the fit
 A rubber outsole to aid with slip resistance
 Interchangeable removable insoles to aid with perspiration problems and accommodate any orthotic devices
 Diabetes shoes with lace fastening system to provide good closure
 A plastizote foam lining that molds to the foot to reduce pressure points and provide customized comfort and protection
 A firm compression EVA mid-sole
 A flared outsole to enhance foot stability
 A polyurethane rocker sole to reduce ball-of-foot pain and absorb shock
 Breathable leather upper
5.4 Current Market/ Comparative Product Chart
The use of this chart will allow the designer to compare and evaluate the current products that are on the market. These products are separated by brand, price, and product information. Each feature shown could inspire a design improvement or new concept. This chart shows a few brands and products that are currently

on

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themarket.

Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Table 2 Comparative Product Chart: Diabetes Shoe

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DESIGNING FOR THE INCAPACITATED
5.5 METHODOLOGY
5.5.1 Step 1: Identify the Objective
Some of the relevant topics researched for this study are as follows, the foot anatomy, common foot problems, the medical foot examination and last but not least, the processes of fashion.
The target user group addressed by this research consists of consumers of specialty shoes; however, the patients vary not only by height, weight, age, sex, and in the exact nature of their physical abnormalities, but also in their personality traits, vocation, and lifestyle.
5.5.2 Step 2: Research
The designer must research all areas of importance to the particular subject.
For this study, the foot anatomy, research of common foot problems, self image and clothing, fashion, study of diabetes, brainstorming for a variety of possibilities, and conducting user surveys has been analyzed to get an understanding the wants of the consumer.
5.5.3 Step 3: Data Collection/Analyzing
Conducting user surveys is a way to get the opinions of consumers and a more focused idea of what to design. I have conducted two surveys to get an understanding of what qualities consumers would like in a specialty shoe.
5.5.4 Brainstorming
This chart shows the characteristics of a normal shoe, diabetes shoe, fashion, and the goal that is attempted to be achieved: development of an improved styled diabetes shoe.

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Fig 24: Diabetes footwear initial concept

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5.5.5 Study 1
5.5.5.1 Sample
Though diabetes is medicated footwear, the purpose of conducting this research is to gather personal characteristics and fashion preferences as an initial step in the development of fashionable shoes for people with diabetes problems. Because the opinions of consumers of diabetes shoes are relevant to this research, the location where data collection took place is Birdem, Apollo and Square hospitals.
There were fifteen participants ranging in ages from 19-75 years. Occupations, lifestyles, and the reason for wearing foot specialty shoes. The participants all wore specialty shoes.
5.5.5.2 Data Collection
The research was conducted over a period of six weeks during office hours. Upon arrival, participants were handed a survey and given a verbal description of what the survey contained. Participants were also told that Birdem hospital was not directly or indirectly a part of conducting this research. The survey completion took approximately 10 to 15 minutes. To protect personal privacy, the participants were not required to list their names and were promised that once research was completed the information would be shredded.
5.5.5.3 Data Analysis
5.5.5.3.1 Questionnaire
A questionnaire was developed to explore the participants’ preferences on styles and fashion, their opinions on the importance of color, and comfortable shoes, their emotional response to having a disability, and their desires in a new and improved specialty shoe.
The questions used a five-point scale to ask for these opinions. Participants were asked to circle a response between SA (strongly agree) and SD (strongly disagree).Once data was collected a sequitur was developed.

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5.5.5.3.2 Survey
5.5.5.3.3 Background Information
1. Age
2. Age you began wearing foot orthotics or specialty shoes
3. Occupation(s)
4. Lifestyle (ex. Parent, grandparent, exercise …)

5. What are your reasons for wearing foot orthotics or specialty shoes?

Read the following statements and respond by circling one of the options at the left of the statement. The options are indicated by the following symbols:
SA= Strongly Agree; A= Agree; N= Neutral
D=Disagree; SD= Strongly Disagree
5.5.5.3.4 Conformity- Individuality
SA A N D SD

1. I feel uncomfortable when my shoes are different from others.

SA A N D SD

2. I am apprehensive of being different from others when I

wear Diabetes shoes.
SA A N D SD

3. I like to dress differently from others as often as possible.

SA A N D SD

4. Wearing shoes that are different from my usual style makes

me feel uncomfortable.
SA A N D SD Other (explain)

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5.5.5.3.5 Style Interests
SA A N D SD

1. I spend more money on my shoes compared to other people.

SA A N D SD

2. Having shoes that are in style is important to me.

SA A N D SD 3. I don’t care whether my shoes are different from others; I wear them because I like them.
SA A N D SD

4. Fashionable shoes are important to me.

SA A N D SD 5. My shoes are highly unique in design.
SA A N D SD 6.
SA A N D SD

Fashion is very important to me.

7. I try to keep my shoes in step with the latest fashion.

SA A N D SD

Other (explain)

5.5.5.3.5 Aspirations
SA A N D SD

1. I would like to keep my future shoes in step with the latest

fashion.
SA A N D SD 2. In the future it will be very important to me that my shoes be comfortable. SA A N D SD 3. In the future I would like there to be a change in the design of Diabetes shoes.
SA A N D SD 4. In the future I would like colors/trends that keep pace with fashion.
SA A N D SD 5. I would like different styles for different occasions and seasons.
SA A N D SD 6. In the future I would like my shoes to express who I am.
SA

A

N

D

SD

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Other

(explain)

Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

5.5.5.4 CIRCLE EACH SHOE THAT IS APPEALING TO YOU

Table 3 Survey Shoe Selection

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Summary and Conclusions
5.5.5.6 Survey Results
I think Diabetic and specialty shoes are:

Fashionable
Strongly A
0%

Disagree
Agree
30%
30%
Strongly D
0%

Neutral
40%

Figure 25: shows the percentages of how the participants felt about the fashion of the current specialty shoe.

Comfortable
Strongly A
0%
Disagree
Neutral 0%
20%
Strongly D
0%

Agree
80%

Figure 26: shows the percentages of how the participants felt about the comfort of the current specialty shoe

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Suitable for activities
Strongly A
0%

Disagree
20%
Neutral
10%

Strongly D
0%
Agree
70%

Figure 27 shows the percentages of how the participants felt about the suitability of the current specialty shoe.
Inexpensive

Strongly D
10%

Strongly A
10%

Agree
20%

Disagree
30%

Neutral
30%

Figure 28 shows the percentages of how participants felt about the cost of the current Specialty shoes.

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Modern
Strongly A
0%
Strongly D
9%
Agree
27%

Neutral
9%

Disagree
55%

Figure 29 shows the percentages of how participants felt about the modernism of the current specialty shoe.

Easy to Use
Strongly D
0%
Strongly A
10%
Neutral
20%
Disagree
0%

Agree
70%

Figure 30 shows the percentages of how participants felt about the usability of the current specialty shoe.

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5.5.5.7 Conformity-Individuality
Conformity: Action or behavior in correspondence with socially accepted standards, conventions, rules, or laws. Individuality: The aggregate of qualities and characteristics that distinguish one person or thing from others.
I feel uncomfortable when my shoes are different from others.
Strongly D
10%
Disagree{
10%

Str ongly A
10%

Ne utr al
0%

Agr ee
70%

Figure 31 shows the percentages of how participants felt about being different from others.

Wearing shoes that are different from my usual style makes me feel uncomfortable.
Strongly D
10%
Strongly A
Disagree
10%
0%

Neutral
30%
Agree
50%

Figure 32 shows the percentages of how participants felt about dressing differently from what they are used to.
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I am apprehensive of being different from others when I wear diabetic shoes.
Strongly D
10%
Strongly A
Disagree
10%
0%

Neutral
20%

Agree
60%

Figure 33 shows the percentages of how participants felt about being different while wearing specialty shoes.
I like to dress differently from others as often as possible.

Disagree
20%

Strongly D
0%

Strongly A
0%
Neutral
20%

Agree
60%

Figure 34 shows the percentages of how participants felt about dressing differently from others.

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5.5.5.8 Aspirations
I would like to keep my future shoes in step with the latest fashion.

Disagree
20%

Strongly A
30%
Strongly D
0%

Agree
10%
Neutral
40%

Figure 35 shows the percentages of participants who want to keep up with the latest fashion.
In the future it will be very important to me that my shoes are
Comfortable
Disagree
Neutral 10%
0%
Strongly D
0%
Agree
30%
Strongly A
60%

Figure 36 shows the percentages of participants who want comfortable shoes.

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In the future I would like there to be a change in the design of specialty
Shoes.
Disagree
0%
Neutral
30%
Strongly D Strongly A
30%
0%

Agree
40%

Figure 37 shows the percentages of participants who would like a change in the
Design of specialty shoes in the future.
In the future I would like colors/trends that keep pace with fashion.

Disagree
0%
Neutral
30%
Strongly D Strongly A
30%
0%

Agree
40%

Figure 38 shows the percentages of participants who would like a variety of colors to keep up with the current fashions in the future.

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In the future I would like more improvement put into the design but nothing taking away from the comfort of the shoe.
Disagree
0%
Strongly A
27%

Neutral
27%
Strongly D
0%

Agree
46%

Figure 39 shows the percentages of participants who would like the aesthetic design to improve, but keep the same comfort.
I would like different style s for different occasions and seasons .
Str ongly D
0%
Dis agr e e
Str ongly A
15%
23%

Ne utr al
31%
Agr e e
31%

Figure 40 shows the percentages of participants who would like different styles for different occasions.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

5.5.5.9 Visual Results
The overlapped colored areas on the chart represent the overall choices that the participants made. A majority of the participants chose the shoes that were comfortable, colorful, and simple in design.

Figure 41 this figure is the chart that was used in the survey for participants to choose their choice of style.
Sixty-five percent of the participants selected shoes that were under the descriptions of classic, formal, dynamic, warm and modern. Thirty-five percent of the participants selected shoes under the descriptions of calm, casual, colorful, pretty, and gorgeous.

5.5.5.10 Survey Conclusion
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 Participants would like a choice of the style options for different occasions
 Participants over the age of forty felt that the appearance of their shoes was less important than comfort. The younger participants worried more about appearance, but also wanted comfort.
 A majority of the participants would like a specialty shoe that is comfortable, yet modern, not too complex in design and is available in a sufficient choice of colors.
5.5.6 Study 2
5.5.6.1 Sample
The purpose for conducting this survey was to get an understanding of what qualities are important to customers when choosing something that is fashionable.
This survey focused on common questions that are related to fashion and also how one becomes aware of fashion.
5.5.6.2 Data Collection
The research was conducted over a period of six weeks. The participants were randomly selected on Dhaka University’s campus, Birdem, Apollo, and Square
Hospitals and were personally handed an information letter and survey. The survey completion took less than five minutes. To protect personal privacy, the participants were not asked their names and were promised that once the research was completed the information would be analyzed and shredded.
5.5.6.3 Data Analysis
5.5.6.4 Questionnaire
A questionnaire was developed to explore the participant’s preferences in the area of design and safety of diabetic shoes. The questions used a Semantic differential rating scale (which is designed to measure connotative meaning of objects, events, and concepts. Participants were asked to circle a numerical response between disagree and agree. Once data was collected each of the results from each participant was placed into charts for visualization.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Survey
1. What is your age group?
a. 19-25
b.25-30

c.30-40

d.40-50

e.60 and older

2. Priorities that one looks for when identifying Diabetic Shoes:
a. Colors
DISAGREE 1

2

3

4

5

6

7

AGREE

b. The design of the item (example: shapes and forms)
DISAGREE 1

2

3

4

5

6

7

AGREE

2

3

4

5

6

7

AGREE

2

3

4

5

6

7

AGREE

c. The materials
DISAGREE 1
d. Comfort.
DISAGREE 1

e. How the item looks once it is tried on.
DISAGREE 1

2

3

4

5

6

7

AGREE

2

3

4

5

6

7

AGREE

4

5

6

7

AGREE

h. use of latest technology ?
DISAGREE 1
2
3

4

5

6

7

AGREE

h. Durability?
DISAGREE 1

4

5

6

7

AGREE

f. Safety?
DISAGREE 1

g. The quality of the item.
DISAGREE 1

2

2

3

3

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Summary and Conclusions
5.5.6.7 Survey Results

Age Groups
60& older
3%

19-25
7%

30-40
21%
40-50
59%
25-30
10%

Figure 42 Age Groups
Priorities that one looks for when identifying fabulous diabetic shoes are: The Colors
14
12
10
8
6
4
2
0

Figure 43 Colors

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

The design of the item (example: shapes and forms)
12
10
8
6
4
2
0

Figure 44 Design

The Materials
12
10
8
6
4
2
0

Figure 45 Materials

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Comfort
16
14
12
10
8
6
4
2
0

Figure 46 Comfort

How the item looks once it is tried on.
25
20
15
10
5
0

Figure 47 how the item looks once on.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Safety
14
12
10
8
6
4
2
0

Figure 48 Create Personal Style

The quality of the item
14
12
10
8
6
4
2
0

Figure 49 Quality

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Use of latest technoloy
10
9
8
7
6
5
4
3
2
1
0

Figure 50 use of latest technology

Durability
8
7
6
5
4
3
2
1
0

Figure 51 Durability

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

ChapterVI

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.1 APPLICATION OF METHODOLOGY
6.1.1 Step 1: Concept finalization

Fig 52: Diabetic footwear initial concept finalization

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6.1.2 Step 2: Color Research
Colors studies should be conducted to be updated on the latest color trends.
Pantone surveys the designers of New York Fashion Week to present to consumers the season’s latest color trends.

Fig 53: pantone fashion color (copyright 2004, Pantone, Inc.)

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

7

Fig 54: pantone fashion color 2005(Copyright 2005, Pantone Inc.)

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

8

Fig 55: pantone fashion color 2006(Copyright 2006, Pantone Inc.)

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.1.3 Step 3: Idea sketching and form development

Fig 56: Hand Sketch (Right side view)

Fig 57: Hand Sketch (Top view)

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.1.4 Step 4: Computer Aided Design
The designer can build a model with a 3D modeling software or a scaled model to acquire an idea of what the product will look like. The various colors are obtained from the color research for 2004-2006.

Fig 58: software generated (Adobe Illustrator) sketch of my model

Fig 59: software generated (Adobe Illustrator) colored sketch of my model

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.2 Hand model prototype and fabrication processes
6.2.1 Materials that have been used to construct the shoe are:
 Softy Goat Leather, pantone color, 1.2mm of thickness
 Boa Lining (fur Tanned leather would be best), cream color,
3.5mm thickness
 Buffalo leather as toe puff, 1.2 mm thickness
 10 mm foam in collar
 Semi rigid shank
 Up shank board
 Insole 3mm double part EVA with tackson board
 In socks, 0.5mm softy nappa.
 Sole: high quality TPR injection molded sole.
 Soft and waxy fastening lace.

6.2.2 Tools used in pattern development

Fig 60: pattern development tools

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.2.3 Development of Patterns

Fig 61: Construction of Shell (master pattern)

Fig 62: Construction of upper components pattern

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Fig 63: Construction of lining components pattern

Fig 64: Construction of bottom components pattern

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.2.4 Product Development

Fig 65: upper material cut components according to pattern

Fig 66: closed upper

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Fig 67: Heat activation of counter stiffener

Fig 68: Back Part Molding

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Fig 69: Mold selection for out sole

Fig 70: molded outsole in TPR injection molding Machine

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Fig 71: Last used for manufacturing

Fig 72: product developed in this project (top view)

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Fig 73: product developed in this project (Side view)

Fig 74: product developed in this project (combination view)

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

6.2.5 Consumption of materials:
Md. Tareq Bin Satter

CONSUMPTION (PER PAIR)
Art.
No:
SL
No.

DT- 786

1

Upper Leather

Material Name

Date:
Description

Goat Soft Leather

Measurment

10-20 Sq.ft.

Color

Brown

Supplier
Name

Thursday, February 10,
2011
Consumption
Sft/Pair
Per Pair

Ruma Leather

3

Lining A

Boa Lining

10-20 sq.Ft.

Cream

Ruma Leather

4

Socks Leather

Cow Softy Nappa

10-20 sq.Ft.

Cream

Sq.ft.
2.30
1.64

Ruma Leather

5

Inter Lining

T.C

6

Insole

Texson Board - 606

7

Outsole

TPR

58x36=14.5 sq.ft 60x35=14.5
Sq.ft
Unit Sole

White

Local Market

Sq.ft.
Sq.ft.

0.65
2.52

Chaina Import

Sq.ft.
Sq.ft.

0.62
Black

Fortuna Self

Pair
1.00

8

Upper Thread

30/3

2500 Mtr

Brown

9

Upper Thread

10/3

1500 mtr

Cream

10

Lining Thread

40/3

2500 Mtr

Beige

11

Reinforcement
Tape
Folding Tape

3 mm

12

Black

3 mm

Black

Banani Shoe
Mt.
Banani Shoe
Mt.
Banani Shoe
Mt.
Banani Shoe
Mt.
Local market

17.50
14.5
23.20

Meter
Meter
Meter
Meter

0.55
Meter
0.36

13

Socks EVA

14

Foam

15

Textile

16

EVA – 3 MM Soft
(Apex)
56X36=14.5 sq.ft

(28x48)=9.33 sq.ft 5 mm canvas Yellow

Local market

0.62

Sq.ft.
Sq.ft.

0.19
0.53

khaki

Lase stick textile

Sq.ft.
Sq.ft.

0.07
17

Shoe Lace

18

Adhesive

19

Solution

20

Black

2.00

Yelow

Grebond Intl.

White

PU AdhesivePU

21

91 cm Long & 9 mm
Dia
Neoprene

National Shoe
Mt.
Grebond Intl.

White

Shank Board

50.40

pcs g g

50.40
60.00

Local Market

g
Sq.ft.

0.43
22

Toe Puff

23

Coller Foam

24

Counter Stiffner

Buffalo

1.2 mm

Bluesh

Chaina Import

White
Chemical sheet

1.2 mm

Local Market

0.31
0.31

Chaina Import

Sq.ft.
Sq.ft.

0.41

Page 78 of 85

Sq.ft.

Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Chapter VII

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

7.1 PHYSICAL TEST REPORT:
Physical test report of Nappa Shoe Upper (goat)
Tensile Strength
Result for Tensile strength & Elongation at break
Perpendicular
Tensile Strength

Parallel

Elongation%

175

Tensile Strength

48%%

Elongation%

182

42%

Result for the Lastometer test:
Lastometer Test
Grain crack strength Kg/cm

Grain bursting strength Kg/cm

30

37

Data for the Stitch Tear Strength:
Stitch Tear Strength kg/cm
Parallel

Perpendicular
125

120

Data for the Water Absorption:
Water Absorption (%)
After 2 hours

After 6 hours

After 24 hours

50%

80%

100%

Data for the Water Vapor Permeability:
Water Vapor Permeability
Leather Sample

250%

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Data for the Wet Rub fastness Test:
Wet Rub fastness
32 Rev

64 Rev

128 Rev

256 Rev

512

Rev

1024 Rev

LR

5

5

5

4

4

2

Felt

5

5

5

4

3

2

Data for the Dry Rub fastness Test:
Dry Rub fastness
32 Rev

64 Rev

128 Rev

256 Rev

512

Rev

1024 Rev

LR

5

5

5

5

5

4\5

Felt

5

5

5

5

5

4\5

Data for Adhesive tests:
Test of adhesion gm\cm
Parallel
250

Perpendicular
360

Data for Heat resistance tests:
Heat Resistance
No change

50 
100



No change

150



No change



Change

200

Data for Vamp flexing tests:
No. of flex

Mandal scale rating

5000

1

10000

2

20000

2

50000

3

80000

4

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

7.2 CONCLUSIONS
7.2.1 SUMMARY OF STUDY
Chapter one set the foundation for this documentation. After stating the problem and the needs for this study, I explain why I was getting interested in doing my project work on diabetic footwear and I outlined the objectives and goals anticipated and the methods of how I would accomplish them.
Chapter two, before getting started, this chapter gives a general overview of footwear including definitions, depiction of history, basic types and need for footwear along with a post mortem report of shoes.
Chapter three, the review of literature examined issues associated with and relevant to understanding the current state of specialty shoes. Understanding the role of diabetic shoes, features of diabetic shoe, the definition of diabetic shoe, the current market, self-image and clothing, and defining fashion helped place the research into perspective.
Chapter four describes about the diabetic with general problems of foot, tips on diabetic foot care, and a general depiction of foot anatomy. It discussed an acknowledgment of the foot, as it is important to understand how the foot functions Chapter five describes the research in profundity and narrows the research down for precision. It discussed all areas considered for designing for a person who has to wear aesthetically unappealing specialty shoes. Understanding the mental state of a person prescribed to wear specialty shoes was studied to better understand how one may feel once they are diagnosed with a disability. Fashion, the main objective for improving unattractive specialty shoes, was analyzed to get direction on how to approach the aesthetic problem. Color, playing an important role in personalization, was also analyzed to see how it could be used to enhance the appearance of specialty shoes.
It includes user surveys and results which were conducted to get personal opinions of consumers and direction for designing an improved specialty shoe and implications of the methods and the design processes used for improvement of specialty shoes.
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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

Chapter six documents the application methods summarized in chapter five and set out for a new product development. Color conception, material selection, sketch development, technical designing, production development under this project etc have been depicted in this chapter.
7.2.2 RECOMMENDATIONS
Due to the lack of fashion varieties in specialty shoes, I believe that others can use this documentation as a guide. I have laid the foundation for developing a process to design for those with Diabetic foot problems; however, it will ultimately be up to the individual designer to incorporate his/her own method in their approach; the same can be said for the final design and fabrication processes of this product.
Taking this into consideration, an in-depth market study is necessary for the development of any product due to ever-changing fashions. Future trends can be identified and predicted. However, trends change rapidly and can be rendered obsolete the moment research is published. Incorporating a survey to help understand the user and the market is important. However it is important to realize that surveys produce opinions and not always facts.

7.2.3 About the reporting:
This project is geared up in coordination with four years course on footwear. I confess my limitation and shortcomings as I failed to make a deep analysis, to make practical trial of my product due to the shortage of time. I am also repentant for any kind of erratum, improper use of technical term, aesthetic lacking of the report. To my best knowledge I didn’t disclose any confidential data of any source but if done so by mistake, I would like to apologize and the respective authority is cordially requested to aware me without disclosing it to anyone. This report contains some Photograph which are collected from the individual source and from the web.
Thanks
Md. Tareq Bin Satter

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

7.2.4 REFERENCES
1. MA Sayeed, H Mahtab, PA Khanam, et al. prevalence of Diabetes and impaired fasting glucose In urban population of Bangladesh. Bangladesh medical research council, Bull.2007; 33(1): 1-12.
2. MA Sayeed, H Mahtab, PA Khanam, et al. prevalence of Diabetes and impaired fasting Glycemia in rural population of Bangladesh. Diabetes care 2003; 26: 1034-1034
3. Statistical pocket book Bangladesh 1995 & 2006.
4. Web site M.V.Hospital, Royapuram, India.
5. Publication yy Tim in Disease, Diabetes, Care, Health, High Blood
Pressure, Pain, Skin Conditions.
6. Anspach, Karlyne. (1967). The Way of Fashion. Ames, Iowa: The Iowa
State University Press.
7. Cailliet, Rene. (1997). Foot and Ankle Pain. Philadelphia, Pa.: Davis.
Damhorst, Mary Lynn, Miller, Kimberly A., Michelman,
8. Susan. (1999).The Meanings of Dress. New York, NY: Fairchild
Publications.
9. Fitting

Fashion.

Retrieved

February

4,

2002,

from

http//www.lib.auburn.edu/find/articles.html
10. Hunter, Skip, Dolan, Michael G., Davis, John M. (1995). Foot Orthotics in
Therapy and Sport. Champaign, Ill.: Human Kinetics.
11. Kaiser, Susan B. (1985).The Social Psychology of Clothing and Personal
Adornment.
12. New York: Macmillan, London: Collier Macmillan.

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Study on Evolving Medicated Footwear for Diabetic Patients by: Md. Tareq Bin Satter

13. Lindemann, James E. (1981). Psychological and Behavioral Aspects of
Physical
14. Disability: A manual for health practitioners. New York: Plenum Press.
15. Newman, Cathy. (2001). FASHION. Washington, DC: the National
Geographic Society.
16. Peterson, Karen. (n.d.). Minding your foot pain. Retrieved July 30, 2006, from www.usatoday.com.
17. Schlachter, Trudy & Wolf, Roberta.( 1999). Millennium Mode, Forecast from 40 top Designers.: New York, New York: Rizzoli International
Publications, Inc.
18. Scholl, Dr. William M. (1946). Practipedics: The science of giving foot relief and Removing the cause of minor foot and shoe troubles: based on the experience, inventions and methods of Dr. William M. Scholl /
American

School

of

Practipedics.

Chicago:

American

Practipedics.
19. Whelan, Bride M. (1994). Color Harmony
20. Rockport, Massachusetts: Rockport Publishers.
21. FootSmart.com. 2006. http://www.footsmart.com/
22. Drew Shoe. 2006. http://www.drewshoe.com/
23. Wikipedia. 2006. http://en.wikipedia.org/
24. Foot Anatomy. 2006. http://www.eorthopod.com/
25. Pantone. 2006. www.pantone.com

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School

of

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