When buying shoes as a diabetic, it is always wise to seek assistance from a Canadian Certified Pedorthist to choose your footwear. This article will cover with some worst-case scenarios; however, every diabetic should be aware of these issues. Education is power!
When fitting shoes, a very important question is whether or not you are diabetic. If yes, is there a possible neuropathy, and have there been blood circulation or nerve conductive tests done? When dealing with diabetic feet, the importance of a proper shoe fitting by a knowledgeable professional cannot be stressed enough.
In order to understand why this is, we need to look at the long-term consequences of what diabetes can do to the feet. In diabetes, the nerves and circulation of the extremities can be damaged due to uncontrolled sugar levels in the blood.
Diabetic neuropathy is a phrase we hear commonly. This is gradual loss of sensation in the extremities, due to destruction of the peripheral nerves. When fitting shoes, a partial or total lack of sensation in the feet can have dire consequences, even so far as amputation, and even death; all because of a poorly fitted shoe.
The whole purpose of proper shoe fitting with diabetics is to ensure that the foot is supported, protected, and the skin is not broken. Our skin is the largest organ of our bodies. It regulates temperature and gives us awareness of our surroundings through touch and temperature sensitivity. It keeps fluids in, stopping us from becoming dehydrated. It protects us from stray microorganisms and pathogens in the environment. If the skin is broken, germs in our world can find their way in.
The other major problem with diabetes is the damage done to the circulation of blood in the extremities. Reduced circulation and accompanying destruction of the small blood vessels in the feet can greatly impede heeling, as the blood factors needed for heeling are not reaching the area. Ulceration, essentially open soars that resist healing because of lack of circulation, can occur from a simple blister. The longer the underlying tissues are exposed to the environment the better the chance of developing an infection is. And with diabetics, Infection can occur even before the problem is noticed.
It is recommended that diabetics with a peripheral neuropathy obtain professional help in choosing footwear and, strangely enough, wear white socks. Why you ask? With white socks, any blood or exudate will be noticed immediately so that measures can be taken to prevent infection immediately. With black or dark socks, damage done to the insensate foot may go unnoticed.
Diabetics with peripheral neuropathy tend to buy shoes that are too small and tie them verry tightly, because of the lack of sensation. They can’t feel the shoe, so they think it is loose, when in actuality it is too small. Because of this, blistering can occur. Because of lack of sensation, they may not realize they are damaging their feet.
Make sure to check your shoes each and every time they are put on to insure there is nothing inside that can damage the feet. I actually encountered a person who walked around all day with a shoehorn in their shoe and did not realize it because of the lack of sensation in their feet, thankfully there was no breakage of the skin.
An individual with diabetic neuropathy, especially those who have a history of ulceration, should wear proper shoes with a good support system, such as a custom orthotic, to spread pressures evenly across the entire bottom of the foot to prevent high pressure areas. Sandals or shoes with even small openings like fisherman’s weaves can allow foreign material like small pebbles to get in.
Some things to watch out for in fitting diabetics include ensuring proper width across the forefoot, especially if there are bunions involved, and making sure there are no seams over the apex of the bunion or other boney prominences. A shoe with a seamless inside is preferred, as even light stitching can cause issues. Length of course is important. At least ¼“ of extra room is needed, as well as appropriate depth for any lesser toe deformities, such as hammertoes and claw toes which are common in the diabetic foot. Heel slippage should be minimal.
A Canadian Certified Pedorthist can help you choose a shoe for your type of foot. Flat, high arches, each type of foot needs shoes with different biomechanical qualities which can affect how we walk therefore stresses placed the feet and lower extremities.
Written by Jaimie McVean, Certified Canadian Pedorthist