Chapter 10 – FOOTWEAR FOR DIABETES

People with normal foot sensation can feel discomfort from poorly fitting shoes, prompting them to change their gait or switch to more comfortable footwear. However, diabetics with nerve damage may not feel this discomfort and may continue wearing inappropriate shoes, which can lead to skin damage and subsequent infections. Although this may seem trivial, inappropriate shoes are a common cause of diabetic foot infections. A well-constructed shoe can help protect the diabetic foot from tissue damage. Later in this chapter, I will discuss the specific features that make a shoe appropriate for diabetic foot care.

SHOES FOR DIABETIC FEET

Measure Your Feet:

Do not rely solely on a designated shoe size. Always have your feet measured while

standing, as they can change in shape and size over time. Foot deformities may worsen with motor neuropathy.

Shoe Length:

Your shoes should be approximately 1/4 inch longer than your longest toe. Shoes that are too large can cause your foot to slide back and forth while walking, resulting in blisters and calluses on the sole.

Heel Height:

I do not recommend that diabetic patients wear shoes with a heel height greater than 1 inch. A higher heel increases pressure on the ball of the foot—the area where ulcers

most frequently develop.

Soft Interior Lining:

The inside of the shoe should be lined with a soft material that is free of wrinkles or seams that could irritate the skin and cause blisters.

Material Matters:

Avoid shoes made of nylon or plastic. Leather is preferred because it breathes better,

absorbing sweat and allowing moisture to evaporate. If sweat remains trapped inside

the shoe, the skin can become macerated. Maceration between the toes is particularly

dangerous because it can allow bacteria to penetrate, leading to rapid spread of infection to the tendons of the foot.

Rocker-Soled Shoes:

Rocker-soled shoes are frequently recommended for diabetic patients because they effectively relieve pressure on the ball of the foot, reducing the risk of ulcers.

Proper Support and Stability:

Commercially available tennis shoes tend to be too flexible and unstable for diabetic

feet. Shoes with a steel shank provide better support by making the shoe stiff from heel

to toe. However, if a steel shank is used, the shoe must also have a rolling (rocker) sole. This combination is especially beneficial for diabetic patients with insensitive feet.

Foot Orthotics

As mentioned in Chapter 2, diabetic patients affected by motor neuropathy gradually undergo structural changes in their feet. The development and worsening of bunions, hammer toes, and calluses are primarily due to the weakening of the muscles and tendons. This weakness can lead to a collapse of the foot's arch as the tendons that support the joints become less effective. To help correct this imbalance, specialized shoe insoles (orthotics) can be used to support the weakened structures and prevent further deformities. The ideal material for diabetic foot orthotics is semi-rigid polypropylene, which strikes a balance between being too rigid and too flexible.

I do not recommend generic arch supports or add-on insoles available in sports stores or pharmacies, as these products are designed for general foot pain relief and do not

address the specific needs of diabetic feet. Diabetic patients with foot deformities, such

as those seen in Charcot's diabetic foot, require custom insoles prescribed by a podiatrist to ensure proper support and protection.

DIABETICS WHO SHOULD USE PRESCRIPTION ORTHOTICS

• Altered sensitivity due to neuropathy.

• Leg and foot circulation problems.

• Structural changes in the foot resulting from motor neuropathy.

• Foot deformities, such as bunions, hammer toes, and calluses on the sole.

• Charcot foot.

• Flat feet.

• Old age.

• Long-standing diabetes.

• History of previous ulcers, amputations, or infections.

• Diabetic foot pain.

SOCKS for Diabetics

Socks are just as important as shoes and insoles in diabetic foot care. Wrinkled socks

can cause irritation and blisters by creating focal pressure on the skin. Ideally, socks

should be made of 100% cotton to effectively absorb sweat. In contrast, nylon stockings tend to retain moisture, which can lead to maceration of the skin. When moisture

accumulates between the toes, maceration may occur, causing the skin to break and

become infected. Additionally, socks should be free of lined seams that cause focal

pressure. Diabetic patients should also avoid patched socks for the same reason. If you

experience excessive foot perspiration, it is advisable to change your socks twice a day.