Long term complications in people with diabetes frequently manifest in foot problems such as infections and ulcerations that can lead to amputation. In fact, foot problems are the leading cause of hospitalization for Canadians living with diabetes.
The majority of foot problems diagnosed in people with diabetes could have been avoided through daily footcare and proper shoe selection. Many people with diabetes have reduced circulation or sensation in their feet (called neuropathy), and are not able to feel if something in their shoe or the shoe itself is irritating their foot. To avoid the development of wounds or ulcers, it is vital people living with diabetes visually examine their feet daily and, when purchasing shoes, have them professionally fitted rather than relying on how their feet ‘feel’.
The Canadian Diabetes Association (www.diabetes.ca) recommends that all people with diabetes should be instructed on proper footcare and have a foot examination at least once a year to avoid the risk of amputation. Foot examinations should include an assessment of any structural abnormalities of the foot such as feet that lean excessively to one side, causing friction between the side of the foot and the shoe, signs of neuropathy and vascular disease, and evidence of any ulcerations and/or infections.
Along with regular foot examinations, a daily footcare routine and proper shoe selection are equally vital to help maintain the health of the feet and protect against foot problems that could lead to amputation. For patients with diabetes, Canadian Certified Pedorthists recommend the following footcare and shoe fitting tips:
Footcare: Pedorthic Pointers for Patients
- Visually inspect your feet daily. Be alert for redness, swelling, broken skin, sores or bleeding. See your doctor immediately if any of these problems arise
- To protect your feet from injury, wear your shoes indoors and outdoors
- Wash your feet with soap and warm water every day, but do not soak them
- Avoid heat pads or hot water bottles even though your feet might get cold easily. With a lack of sensation it is easy to burn your feet if the water is too hot
- Avoid socks with heavy seams as they can irritate the skin which can lead to breakdown or ulceration
- Avoid tight constrictive socks and clothing that can limit blood flow
Shoe Selection: Pedorthic Pointers for Patients
- Have your shoes professionaly fitted by a trained specialist such as a Canadian Certified Pedorthist
- Select footwear with the following features: soft upper with minimal seams; deep, wide toe boxes; firm but cushioned soles; removable insoles; strong heel counters; and rockered soles
- Lace up shoes offer a versatile fit and should be used if possible. However if tying laces is difficult select footwear with Velcro closures
- Avoid slip-on and restrictive footwear such as high heels with pointed toes or shoes that are narrow in style as they depend on a tight fit to stay on the foot
- When purchasing shoes, remove the insole and stand on it. If your foot overlaps any area, the shoe is too narrow or too short for your foot
- Make sure there is a full finger width between the end of your longest toe and the end of your shoe
- Avoid seams over the toe area of your shoes as seams resist stretching and create bumps that can rub against your skin and cause it to break down or ulcerate
- If you have a problem with lower limb swelling, talk to your Pedorthist about graduated compression stockings to help control the swelling and improve the fit of your shoes over the course of a day
If you are experiencing foot pain or discomfort, talk to your doctor or book an appointment with a Canadian Certified Pedorthist for pedorthic management services including orthopaedic footwear, shoe selection guidance and orthotics.