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218closely examined. In addition to the shoes worn when visiting the outpatient clinic, it is necessary to examine the shoes that the patient uses frequently and also work footwear to confirm the effects of footwear on foot lesions24）.Calluses and clavus on the feet unaccompanied by significant deformities are often indicative of footwear-induced lesions, which may be associated with an inappropriate size, high heels, and thin soles of shoes, as well as shoes with many designs and stitches at the back of the foot. Ingrown toenails, hallux valgus, and little toe varus are often caused by narrow-toed shoes, inappropriate shoe sizes, and high heels.In addition to the type of footwear, the manner in which it is worn can result in foot lesions; shoes with loosely tied laces or those in which the foot is not well secured result in back and forth slippage of the foot and instability. Therefore, shoe-induced chafing, calluses, and clavus tend to occur more frequently, and toes are pushed into the shoe tip during the kicking motion of walking, which results in ingrown toenails.Patients with diabetic neuropathy experience sensory loss and therefore prefer tighter shoes owing to the sensation that their footwear does not fit correctly. Poorly fitting footwear can cause shoe chafing; therefore, patients with diabetic neurop-athy should undergo careful footwear evaluation25）.4-2. Foot careFootcare includes care of lesions such as calluses and nail treatment, as well as foot self-care guid-ance. Footcare should be prioritized based on the results of evaluation, and issues that require urgent attention should receive immediate care. Care is selected within the scope of self-care that can be implemented by the patient and family, and the method of implementation is taught. Patients and their families who cannot perform self-care should be referred to nursing care and welfare services. In this section, the specific content of foot care will be explained.4-2-1 Nail careNail clipping, trimming of thickened nails, and correction of ingrown nails are components of nail care. Usually, square-off nail trimming is recom-mended; the tip of the nail blade is cut straight and only the nail corners are rounded using a file (Figure 4). However, nails should be trimmed care-fully to avoid skin injury considering the patient’s foot shape in those with toe deformities including bunions. Periungual inflammation may occur secondary to the accumulation of plaque around the nail in patients with thickened or ingrown nails26). Taping and cotton packing may be useful for symptomatic treatment of ingrown nails and ingrown toenails; however, angle correction is necessary for pain or wounds. Ingrown nails and ingrown toenails often develop secondary to the shoe design and manner in which they are worn; therefore, it is necessary to provide guidance regarding the appropriate method of wearing shoes to prevent recurrence.4-2-2 Care of calluses and clavus deformitiesHardened, painful, bleeding calluses and clavus should be trimmed, and patients should be educated regarding factors that predispose to callus forma-tion, such as foot deformities, shoe design, manner of wearing shoes, and an individual’s gait. The patient should also be instructed regarding daily cleansing and moisturizing care, because dryness causes friction and aggravates calluses. Alignment correction and decompression using plantar orthoses are effective for patients with calluses and clavus deformities. It is important to coordinate with pros-thetists to improve these conditions. Patients who do not improve with outdoor foot orthoses alone require prostheses for indoor use as well . Taping Figure 4　square-off