People who suffer from diabetes can have problems with circulation, nerves, immunity, and deformity. Occasionally one or more of these may exist as an isolated issue but often people suffer from more than one at the same time.
Proper footwear is therefore very important for people with diabetes. Your foot and ankle orthopaedic specialist can help you choose proper footwear and recommend shoe modifications to protect your feet.
The shoes often are prescribed by foot and ankle orthopaedic specialists and fitted by a group of professionals called pedorthotists. The shoes may be designed to have a very stiff sole and rocker bottom foot to decrease the forces sent to the ball of the foot. They also may have a bar or wedge applied to the sole to even out the weight distribution on the foot. Shoes will be designed to prevent any seams that are inside the shoe from rubbing against the foot.
There can be several benefits to wearing custom shoes:
Any area where there is too much pressure on the foot can lead to skin breakdown. Footwear should help to relieve these high-pressure areas and therefore reduce the occurrence of related problems.
The footwear should decrease both the amount of vertical pressure, or shock, on the bottom of the foot, as well as reduce the horizontal movement of the foot within the shoe, or shear.
Deformities resulting from conditions such as collapse of the arch, loss of fatty tissue, hammer toes and amputations must be accommodated. Many deformities need to be stabilized to relieve pain and decrease the risk of progression of the deformity.
Limiting the motion of certain joints in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot.
If the shape of your foot has begun to change, or you’ve noticed skin breakdown, redness or swelling, you should make an appointment with your foot and ankle orthopaedic specialist for an evaluation. That being said, shoe wear is just one area of potential benefit and this evaluation would take into account your other medical problems and available treatment options. Depending on the findings, shoe inserts, wedges, custom arch supports, or special shoes may be recommended. When there is concern for ulceration and infection, your foot and ankle orthopaedic specialist may recommend other treatments first, including special types of casts and skin care and possibly even surgery.
Many diabetics need special footwear prescribed by a physician. Prescription footwear includes:
Immediately following surgery or as part of treatment of an ulcer, some type of shoe may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe) and post-operative shoes.
The in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4- to 1/2-inch of depth throughout the shoe, allowing extra volume to accommodate any needed inserts or orthoses, as well as deformities commonly associated with a diabetic foot. In-depth shoes also tend to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.
This involves modifying the outside of the shoe in some way, such as modifying the shape of the sole or adding shock-absorbing or stabilizing materials.
An orthosis is a removable insole which provides pressure relief and shock absorption. Both off the shelf and custom-made orthoses or inserts are commonly prescribed for patients with diabetes, including a special total contact orthosis, which is made from a model of your foot and offers a high level of comfort and pressure relief.
When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient’s foot. These cases are rare. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.
Similar to the regular shoes that you have worn in the past, with the exception that occasionally the upper portion of the shoe may be made from a type of leather that stretches better such as deer hide. This softer leather can be stretched or will stretch as you continue to wear it and it adjusts itself to the shape of your foot. Unfortunately, this comes at a cost since this type of leather is less durable. Independent of the type of leather used, if the shoe is beginning to break down, it should again be evaluated by the pedorthotist or other individual who fitted you or with your foot and ankle orthopaedic specialist.
There are many styles of special shoes. They may look different than regular shoes and sneakers, but usually aren’t heavier.
If the shoes don’t feel right, you should speak with the professional who fitted or made them or your foot and ankle orthopaedic specialist, as changes to the footwear may be needed.
Rarely. Shoes that can be ordered and then fitted, often with some arch supports, will do the job most of the time. However, if custom shoes are necessary, a pedorthotist can often assist you in this process.