Researchers have provided a wide range of discoveries regarding socks, footwear and foot health. Below we present abstracts from research papers of possible interest to athletes, diabetics, walkers and people with sensitive feet.

We offer no medical advice and make no medical claims regarding our products. We strongly encourage you to seek professional medical assistance for proper foot care.

Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes

Adam P. Garrow, PhD; Carine H.M. Van Schie, PhD; Andrew J.M. Boulton, MD; in Diabetes Care 28:2001–2006, 2005

Objective — High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.
Research Design And Methods — Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40–80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas.

Results — The results showed a significant increase in maximum foot contact area of 11 cm2 (95% CI 7–11) when subjects wore the PFC socks (P_0.01). This was accompanied by 5.4 kPa (3.5–7.3) or 9% reduction in total foot pressure (P_0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.

Conclusions — These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients.

Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration

Matthew L. Maciejewski, PhD; Gayle E. Reiber, MPH, PhD; Douglas G. Smith, MD; Carolyn Wallace, PhD; Shane Hayes, CPED; Edward J. Boyko, MD; In Diabetes Care 27:1774–1782, 2004

Objective — To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors.

Research Design And Methods — We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study population, components of the intervention, and level of adherence were evaluated. U.S. Preventive Services Task Force criteria for evaluating research were applied to rate each study on study design and internal validity.

Results — Risk ratios in all studies assessing the association between therapeutic footwear and reulceration were below 1.0, suggesting some protective footwear benefit. However, in the most rigorous experimental study, no statistically significant benefit was observed between control patients wearing their own footwear and intervention patients wearing study footwear. Annual reulceration in these studies’ control groups ranged from 8.4 to 59.3%. In patients with severe foot deformity or prior toe or ray amputation, observational Studies Suggested A Significant Protective Benefit From Therapeutic Footwear.

Conclusions — Therapeutic footwear has been used for decades as one of many strategies to prevent reulceration in patients with diabetes and foot risk factors. The findings of several studies reporting statistically significant protective effects from therapeutic footwear may have been influenced by several design issues. When considering the appropriateness of therapeutic footwear recommendations for moderate-risk patients, clinicians and patients should jointly explore individual strategies to decrease events that lead to foot ulcers.

Therapeutic Footwear in Diabetes – The good, the bad, and the ugly?

Andrew J.M. Boulton, MD, FRCP; Edward B. Jude, MD, MRCP; In Diabetes Care, Volume 27, Number 7, July 2004

In recent years, it has generally been accepted by the diabetes community that “good” footwear prevents foot ulceration. Indeed, it is virtually an axiom of diabetes care that a patient with a history of foot ulcer is a footwear patient for life. Similarly, most health care professionals believe that “bad” footwear is a major cause of ulceration in diabetes and that in the past, the fact that most therapeutic footwear was perceived as “ugly” resulted in poor compliance when such footwear was prescribed (2). Where is the evidence to support these beliefs? The last two points are easier dealt with than the first.

The Efficacy of Padded Socks in Reducing In-Shoe Plantar Foot Pressure in High Risk Patients with Diabetes

Garrow AP; van Schie CHM; Boulton AJM; in a lecture at the Diabetes Foot Clinic, Disablement Services Centre, Withington Hospital, Cavendish Road, Manchester, UK

Conclusion – The wearing of PFC socks significantly reduces both total contact pressure and average peak plantar pressure. This pressure reduction is as a result of increased total foot contact area. Future work will determine whether these pressure reductions can be maintained and whether the wearing of padded hosiery reduces the incidence of foot ulcers in diabetes.

Effect of Therapeutic Footwear in Foot Reulcerations in Patients With Diabetes - A Randomized Controlled Trial

Gayle E. Reiber, MPG, PhD; Douglas G. Smith, MD; Carolyn Wallace, PhD; et al; in JAMA, May 15, 2002 - Vol 287, No. 19

Design, Setting, and Participants - Randomized clinical trial of 400 diabetes patients with a history of foot ulcer in 2 Washington Sate health care organizations who did not require custom shoes for foot deformity and were enrolled between August 1997 and December1998 and followed up for two years. Data collected at regular intervals documented physical, foot, and diabetes characteristics; footwear use; foot lesions; and ulcers.

Conclusions – This study of persons without severe foot deformity does not provide evidence to support widespread dispensing of therapeutic shows and inserts to diabetic patients with a history of foot ulcer.

Skin Friction Management, an Emerging Apparel and Textile Science

Jaime Ampuero - DuPont de Nemours International S.A., Advanced Fiber Systems, Geneva, Switzerland; Siegfried Derler - Swiss Federal Laboratory for Materials Testing and Research, St. Gallen, Switzerland; presented at Avantex Symposium – Frankfurt am Main – May 2002


Market demand for garments providing higher comfort, protection and performance has grown in recent years. In response to this trend a promising new field of research has emerged; which studies the complex effects of apparel friction against the human skin on the sensitivity, wellbeing and satisfaction of different wearers; and it involves development of techniques to simulate and characterize the friction between textiles and skin. A better understanding of the relationships between friction, heat, humidity and skin responses will help to design innovative garments. Technologies including DuPont Teflon® fluorofibres and textile treatments are available for apparel designers who aim at minimizing mechanical irritation of the skin during cyclic dynamic movements. Friction management of apparel parts that rub the skin is a challenge and opportunity in the quest to produce novel garments that satisfy the ever more diverse user needs and desires. This work presents a detailed tribological description of textile-skin systems in terms of contact pressure, friction coefficient, surface composition and topography, heat generation and their evolution in time. The case of Teflon® Fibers is discussed.

Sockwear Recommendations for People With Diabetes

Carol B. Feldman, MSN, RN, CDE, and Ellen D. Davis, MS, RN, CDE; in Diabetes Spectrum Volume 14, Number 2, 2001

Summary – Clearly, diabetes educators and other health care professionals often base advice on tradition rather than on scientific evidence. The available evidence suggests that people with diabetes who have “normal” feet should be able to wear whatever socks they find to be comfortable. Socks should fit well, without constricting cuffs, lumps, or uncomfortable seams. Therefore, fitted socks are preferable to tube socks. Lighter-colored socks may alert wearers with compromised sensation to a draining wound. Patients can judge for themselves which type of fabric feels the most comfortable. Patients who are at risk for ulcer development because of decreased pressure sensation should be advised to wear densely padded socks. In the studies cited here, the padded socks used were the Thorlo brand, which are made of 100% acrylic fiber with nylon and spandex for elasticity. Because cotton was not used, it is difficult to say whether a 100% cotton padded sock would also produce less vertical pressure. Herring and Richie found that padded acrylic socks produce less moisture at the skin surface and less blistering in runners than do cotton socks. Therefore, educators should recommend that their patients wear padded acrylic socks when engaging in vigorous exercise.

Role of Experimental Socks in the Care of the High-Risk Diabetic Foot - A multicenter patient evaluation study

Heather]. Murray, DPOD M; Aristids Veves, MD; Matthew J. Young, MD; Douglas H . Richie, DPM; Andrew J.M. Boulton, MD; American Group For The Study Of Experimental Hosiery In The Diabetic Foot; in Diabetes Care, Vol. 16, Number 8, August 1993

Objective - To assess the acceptability of specially designed socks to provide satisfactory pressure relief in the insensitive, high-risk, diabetic foot. We have conducted a longitudinal multicenter patient evaluation study to assess the acceptability of such hosiery in neuropathic diabetic patients.

Research Design And Methods - A group of 86 neuropathic diabetic patients (69 males, 14 with type I diabetes) with a mean age of 63 yr (range 34-85 yr), and a diabetes duration of 16 yr (range 1-45 yr) participated in the study. Peripheral vascular disease was present in 28 (33%) patients, previous foot ulceration in 39 (44%) patients, and active ulceration was present in 11 (13%) patients. All patients were provided with three pairs of specially designed socks and 80 patients with extra- depth shoes. Evaluation and foot examination were performed at 3 and 6 mo.

Results - Socks were worn for a mean of 6 days/wk (range 1-7 days/wk) . Patient satisfaction evaluated at both visits was good or very good in 85%, average in 12%, and poor in 3% of patients. Ten ulcers healed during this period, and seven new ulcers occurred. Intention to continue wearing the socks, most or all of the time, was expressed by 84% of patients.

Conclusions - We conclude that the experimental socks have a high level of patient satisfaction when worn with suitable shoes, and may be an acceptable and inexpensive addition to existing methods of protecting the high-risk insensitive diabetic foot.

Studies of Experimental Hosiery in Diabetic Neuropathic Patients with High Foot Pressures

A. Veves; E.A. Masson; Fernando; Boulton; Department of Medicine, Manchester Royal Infirmary, Manchester, UK; in Diabetic Medicine, 1990, Vol. 7, 321-326

High plantar pressures and painless trauma are associated with the development of foot ulcers in diabetic patients. Padded hosiery has been reported to reduce plantar pressures in patients at risk of ulceration. Using the optical pedobarograph we have studied 10 patients who regularly wore experimental padded hosiery for 6 months. The hosiery continued to provide substantial and significant reduction in peak forefoot pressures at 3 months (mean reduction 15.5 %, P < 0.01) and 6 months (17.6 %, P< 0.01), although the level of reduction was less than that seen at baseline (31.3 %, P< 0.05). In addition, commercially available hosiery designed as sportswear has been tested, and compared with experimental hosiery. Although these socks (with high or medium density padding) provided significant pressure reduction versus barefoot (mean 17.4 % and 10.4 %, P < 0.01), this was not as great as that seen with experimental hosiery (27 %, P< 0.05).

Thus the use of socks designed to reduce pressure stress on diabetic neuropathic feet is effective, and continues to be so for a considerable period of time. Commercially available sports socks may also have a place in the management of the diabetic insensitive foot.

Friction Blisters and Sock Fiber Composition - A Double-Blind Study*

Kirk M. Herring, DPM; Douglas H. Richie, Jr, DPM; in Journal of the American Podiatric Medical Association, 1990 Feb;80(2):63-71

A Longitudinal double-blind study was conducted to determine the effect of sock fiber composition on the frequency and size of blistering events in long-distance runners. Thirty-five long-distance runners participated in this study. Two different socks were tested, which were identical in every aspect of construction except fiber composition. One test sock was composed of 100% acrylic fibers, and the other test sock was composed of 100% natural cotton fibers. The results showed that acrylic fiber socks were associated with fewer blistering events and smaller blisters when compared directly to cotton fiber socks.

Use of Experimental Padded Hosiery to Reduce Abnormal foot Pressures in Diabetic Neuropathy

Aristidis Veves, MB; Ewan A. Masson, MRCP; Devaka '.5. Fernando, MRCP; Andrew J.M. Boulton, MD; in Diabetes Care 12:653-55, 1989

High pressures under the feet of diabetic patients with neuropathy are associated with the development of plantar ulceration. The aim of management is the reduction of such stresses with orthoses and insoles. An American hosiery manufacturer has developed socks designed to reduce stress on athletes' feet, and we report a preliminary evaluation of this technique in the reduction of elevated plantar pressure in 27 neuropathic diabetic patients. With a computerized optical pedobarograph, three footsteps on each side were recorded under three conditions: 1) barefoot, 2) wearing the patients' own hosiery, and 3) wearing experimental patented padded hosiery. The patients' own hosiery did not have a significant effect on plantar pressure, but the experimental hosiery reduced both peak forefoot pressure and the area under the time pressure curve (P < .001) by a mean of 26 and 29%, respectively. We conclude that the experimental hosiery IS effective in reducing vertical pressures under the diabetic foot and, in conjunction with established orthotic techniques, may be a useful addition to the treatment of the diabetic patient at risk for foot ulceration.

Silver-Coated Nylon Fiber as an Antibacterial Agent

Patricia C. Mackeen; Stanley Person; Susan C. Warner; Wallace Snipes; S. Edward Stevens, Jr.; Department of Molecular and Cell Biology, The Pennsylvania State University, University Park, Pennsylvania; in Antimicrobial Agents And Chemotherapy, Jan. 1987, p. 93-99

A blend of nylon fiber and silver-coated nylon fiber (the latter known as X-static) was used in these experiments. This fiber was bactericidal when bacteria were exposed to it directly or to an extract derived from its prior incubation in salt solution. At ambient temperatures, a rapid exponential decrease of survival occurred, usually after a delay of approximately 1 h. The rate of killing (decrease of survival) increased with an increase in X-static percentage of the fiber blend, temperature of fiber extraction, concentration of Tris buffer present during extraction, and temperature at which bacteria were exposed to the extract. When bacteria were exposed to the extract at 37°C as opposed to ambient temperature, there was no delay in onset of killing. Escherichia coli was generally the indicator organism tested, but comparable results were also found for Pseudomonas, Klebsiella, Staphylococcus, and Streptococcus species. The rate of killing increased with increasing silver ion concentration of the fiber extract, as determined through atomic absorption spectrophotometry. The rate of killing was greater and the onset was earlier with an extract containing silver ions from fiber than with a salt solution containing the same concentration of silver ions from silver nitrate. Studies of the kinetics of ion release suggested that X-static may be an effective, sustained-release antibacterial agent.