Dr. Tyson Green, Podiatric Specialist
Foot problems are a well-known risk associated with diabetes. Diabetes is the number one cause of lower limb amputations in the United States.
The disease can cause reduced blood flow to the feet, depriving them of oxygen and nutrients. This makes it more difficult for blisters, sores, and cuts to heal. Diabetic nerve damage called peripheral neuropathy can cause numbness in your feet. When you can't feel cuts and blisters, you're more likely to get sores and infections. If you don't notice or treat these sores, they can become deeply infected. This is what typically leads lead to amputation.
Serious foot problems are not an inevitable part of having diabetes, awareness of the risk is critical, along with proper foot care. Many potential problems can be avoided by wearing the right shoes. It sounds simple, but if you have diabetes, there's a lot more than a quick trip to the mall involved when it comes to shoe shopping.
Experts estimate that poorly fitting shoes are involved in half of the serious foot problems that lead to ulcers and foot amputations. In fact, a recent study published in the International Journal of Clinical Practice found that only one in three adults with diabetes wears shoes that fit properly.
Fit and construction are important to consider when choosing diabetes-friendly shoes. If your disease is well-controlled, and you have no history of decreased sensation or foot wounds, you may not need what people commonly call 'diabetic' shoes. You can just focus on getting a good shoe with a good fit, and checking your feet regularly for any problems. But if you have uncontrolled blood glucose levels or a history of foot complications, such as ulcers, therapeutic shoes are recommended. For high-risk patients, protective shoes and orthotic inserts provide a frontline for preventing foot ulcers. This is why we make those available in our office, along with the services of a certified diabetic shoe fitter.
Therapeutic shoes must meet certain requirements from the U.S. Food and Drug Administration to qualify for Medicare Part B coverage. These shoes have to have extra depth, be able to accommodate custom inserts, and must have protective features that diabetic shoes need, like a protective toe and heel.
Whether choosing regular or diabetic shoes, the main thing to look for is a good fit. Well-fitting doesn't just mean the right size, but that your shoes are not too tight or too loose to prevent friction and injury.
Here are some shopping suggestions to ensure a good fit and minimize the risk of complications:
- Spacious toe box: This area around the toes should be wide and not constrictive.
- Wide foot bed and deep interior: This allows for foot swelling during the day. A spacious interior provides room for cushioning inserts.
- Breathable material: Bacteria and infections thrive in warm, damp environments. Leather and many synthetics help deflect moisture.
- Insole cushioning: Ample padding minimizes pressure on the foot's sole.
- Adjustable closure – laces or buckle: This accommodates any food swelling that occurs throughout the day.
- Seamless interior: Raised seams can cause friction and irritation.
- Closed design: This keeps debris out, which can be tough to detect if you have decreased sensation in your feet.
- Hard outsole: Hard rubber soles protect your feet from sharp objects.
- Low heel: High heels create pressure points on the balls and heels of the feet that can lead to calluses and ulcers. Wide, square heels less than 1-2 inches in height are best.
- Socks: Diabetic socks aren't a must, but they do offer padded soles and gentle elastic. Look for synthetic fibers, which wick perspiration away from your skin.
Smart Shopping Tips:
- Have your feet measured periodically because feet can change in size over time.
- Shop later in the day because feet can swell throughout the day.
- Wear new shoes for one to two hours and then check your feet for any cuts or blisters. The next day, wear them for three to four hours, and so on each subsequent day, until they feel comfortable.
- Wear the type of socks or hosiery you will be wearing with the shoe when you try it on.
- The distance between your longest toe and the tip of your shoe should be one-half your thumb's width, so you have the right amount of space to fit your feet.