Using the Slipping Slipper Sign as a Public Health Message to Protect the Feet of Patients With Diabetes

The Fit India Movement is a nationwide campaign to promote and encourage the incorporation of physical activity and sports into the daily lives of the Indian people. Amongst the objectives is to instill the importance of fitness in students and their families, certainly a most worthy endeavor. Whilst we fully support the promotion of fitness activities among persons of all age groups in India, we would yet like to extend a word of caution regarding barefooted exercising, especially among those persons afflicted with diabetes mellitus. These persons are at greatly increased risk of foot trauma and ulceration. A multidisciplinary approach to caring for diabetes is costly and therefore impractical in low-resource areas. We therefore wish to highlight the “slipping slipper sign”, that is, unrecognized loss of a slipper from a person’s feet while walking, which has been demonstrated to reflect severe peripheral neuropathy. This sign can be elicited by nonmedical staff and is an effective method of identifying high-risk patients who warrant further specialized testing for peripheral neuropathy.