Shoes for the Diabetic Foot

Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal everyday functions. Insulin is a substance produced by the pancreas gland that helps process the food we eat and turn it into energy.

Diabetes affects approximately 16 million Americans and is classified into two different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked to heredity. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have not attended to their diet properly.

Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet. People with diabetes should pay special attention to their feet.

Of the 16 million Americans with diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy. Diabetic neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as bunions, hammer toes, and Charcot foot.

Diabetics should take preventative foot care measures to reduce the risks of serious foot conditions. Daily observation of the feet is critical.

Diabetes often leads to peripheral vascular disease that inhibits a person’s blood circulation. With this condition, a narrowing of the arteries frequently leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, causing injuries to heal poorly. Poor circulation can also lead to swelling and dryness of the foot. Preventing foot complications is critical for the diabetic patient because poor circulation impairs the healing process and can lead to ulcers, infection, and other serious foot conditions.

Footwear and orthotics play an important role in diabetic footcare. Orthotics designed with Plastazote foam, the #1 material for protecting the insensitive diabetic foot, are usually recommended. Plastazote is a material designed to accommodate pressure hot spots by conforming to heat and pressure. By customizing to the foot, Plastazote provides the comfort and protection needed in diabetic footcare. Footwear constructed with Plastazote is also recommended frequently for the diabetic patient. Footwear for individuals with diabetes should contain the following features:

• Soft leather uppers or flexible materials
• Seemless, smooth interior
• High, wide toe box
• Removable insoles for fitting flexibility and the option to insert orthotics if necessary.
• Rocker soles designed to reduce pressure in the areas of the foot most susceptible to pain, most notably the ball of the foot
• Firm heel counters for support and stability

If you are a diabetic, pay attention to any problems you may be having with your feet. Diabetics with neuropathy especially should take necessary precautions to prevent injury and keep their feet healthy.

If you have diabetes and are experiencing a foot problem, immediately consult your doctor. Your Fit Specialist at Stan’s will advise you on appropriate footwear for your condition.

Proper footcare is especially critical for diabetics because they are prone to foot problems such as:

• Loss of feeling in their feet
• Changes in the shape of their feet
• Foot ulcers or sores that do not heal

Simple daily footcare can prevent serious problems. According to the National Institute of Health, the following simple everyday steps will help prevent serious complications from diabetes:

• Take care of your diabetes
Make healthy lifestyle choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your lifestyle.

• Check your feet every day
You may have foot problems you’re unaware of. Check your feet for cuts, sores, red spots, swelling, or infected toenails. Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror or ask a family member to help you. Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.

• Wash your feet every day
Wash your feet in warm, not hot, water. Do not soak your feet because your skin may become drier. Before bathing or showering, test the water with a thermometer or your elbow to make sure it is not too hot. Dry your feet well, including between your toes. Use talcum powder to keep the skin dry between the toes.

• Keep the skin soft and smooth
Rub a thin coat of skin lotion or cream on the tops and bottoms of the feet. Do not put lotion between your toes, as it may infection.

• Wear shoes and socks at all times
It is extremely easy to step on something and hurt your feet, so always wear seamless socks, stockings, and nylons with your shoes to help avoid blisters and sores. Choose seamless socks made of materials that wick moisture away from your feet and absorb shock and shear. Before putting shoes on, always check the insides to make sure the lining is smooth and there are no foreign objects, such as pebbles. Wear shoes that fit well and protect your feet.

• Protect your feet from hot and cold
Always wear shoes at the beach or on hot pavement. Use sunscreen on the tops of your feet, and keep your feet away from radiators or open fires. Do not use a hot water bottle or heating pad on your feet. If your feet are cold, wear seamless socks at night. Lined boots are good to keep your feet warm in the winter. Do not wear socks with seams or bumpy areas. Choose padded socks to protect your feet and make walking more comfortable. In cold weather, check your feet often to keep your feet warm and avoid frostbite.

• Keep the blood flowing to your feet
Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 to 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs. Do not cross your legs for long periods of time. Do not wear tight socks, elastic, rubber bands, or garters around your legs. Do not wear restrictive footwear or foot products that can cut off circulation to the feet, such as products with elastic. Do not smoke. Smoking reduces blood flow to your feet. If you have high blood pressure or high cholesterol, work with your health care team to lower it.

• Let your doctor do the trimming
Whenever possible, have your toenails trimmed by your foot doctor or medical professional, as serious damage and injury can be done to feet during the trimming process or removal of calluses.

• Be more active
Ask your doctor to plan an exercise program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and jumping. Always include a short warm-up or cool-down period. Wear protective walking or athletic shoes that fit well and offer good support.

• Communicate with your doctor
Ask your doctor to check the sense of feeling and pulses in your feet at least once a year. Ask your doctor to tell you immediately if you have serious foot problems. Ask your doctor for proper footcare tips and for the name of your local podiatrist.

If the problem persists, consult your doctor. Your Fit Specialist at Stan’s will advise you on appropriate footwear for your condition.

• Try on shoes late in the day when feet are bigger.
• Have both feet measured, as you stand, each time you buy shoes.
• Allow 3/8” to 1/2” room between the end of the longest toe and the end of the shoe; your foot continues to move forward inside the shoe even when the grip stops the shoe from moving.
• Select the shape of the shoe that matches the shape of your foot.
• Choose styles with lace or velcro closures, rounded toes, soft leather uppers, and shock absorbing outsoles.
• Judge each shoe by how it fits, as foot size may differ from shoe size.
• Fit the ball of the foot at the widest part of the shoe. This is where the shoe is designed to flex.
• Walk in the shoe to make sure it fits without pressure to the front of the foot.
• Avoid excessive heel slippage. Some heel slippage may be unavoidable due to the inflexibility of new shoes. Reduce heel slippage without making the shoe too tight in front.
• Avoid wearing shoes that are too tight, expecting them to stretch.
• Inspect feet for pressure and redness twice each day.
• Alternate footwear daily to reduce the risk of repetitive pressure and shear that can build up when wearing one pair of shoes. It is unlikely that different pairs will cause the exact same pressure.
• Regularly make sure shoes are tied or strapped securely on the foot to avoid movement of the foot inside the shoe.
• Wear new shoes no more than one hour the first day, increasing the time worn by one hour each day, to reduce the stress of wearing the new footwear. Check for any redness or “hot spots” the new shoes may cause.
• Maintain shoes in a hygienic manner for optimum shoe fit. Use cedar wood shoetrees to absorb moisture and maintain shoe fit and shape.
• Regularly repair heels, soles, and upper linings to help increase comfort, durability, and fit.
• Conduct a shoe fit evaluation on a regular basis to make sure shoes haven’t become too tight due to change in the foot shape and size. Also, make sure the shoes have not stretched and become loose, which can cause excessive shear, or the linings haven’t worn out at points of excess pressure.