November 14  is World Diabetes Day, and as that time rolls around, here are some important guides for persons living with this disease process. Proper footwear is an important part of life as a person with diabetes. With the possibility of neuropathy or lack of sensation, wearing the right footwear is crucial. By accessing a doctor or podiatrist, many patients can prevent serious diabetic foot complications.

Objectives

Footwear for people with diabetes should achieve the following objectives:

• – Relieve areas of excessive pressure – Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high-pressure areas, and therefore reduce the occurrence of related problems.
• – Reduce shock and shear – A reduction in the overall amount of vertical pressure, or shock on the bottom of the foot, is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.
• – Accommodate, stabilise and support deformities – Deformities resulting from conditions such as Charcot involvement, loss of fatty tissue, hammer toes, and amputations, must be accommodated. Many deformities need to be stabilised, to relieve pain, and avoid further destruction. In addition, some deformities may need to be controlled or supported to decrease their progression.
• – Limit motion of joints – Limiting the motion of certain joints in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot.

Shoes

If you are in the early stages of diabetes, and have no history of foot problems or any loss of sensation, a properly fitting shoe made of soft materials, with a shock absorbing sole, may be all that you need. It is also important for patients to learn how to select the right type of shoe in the right size, so that future problems can be prevented. The excessive pressure and friction from the wrong kind, or from poorly fitting shoes, can lead to: blisters, calluses, and ulcers, not only in the insensitive foot, but also in feet with no evidence of neuropathy.

In achieving proper shoe fit, both the shape and size of the shoe must be considered. You should try to match the shape of the shoe to the shape of your foot. This means that you should ensure your shoes have adequate room in the toe area; over the instep; and across the ball of the foot. Also, there should be a snug fit around the heel.

When considering your correct shoe size, remember that the width is just as important as the length. The proper shoe size is one where the widest part of the foot, which lies across the foot at the base of the toes, is in the widest part of the shoe. There should be too, 3/8 to 1/2 inch between the end of the shoe, and the longest toe. Additionally, a shoe with laces is recommended, to provide the adjustability needed for any swelling or other deformities. As well, it would allow the shoe to fit properly, without any danger of slipping off.

Prescription Footwear

Many diabetics need special footwear prescribed by a physician and include:

• – Healing shoes – Immediately following surgery or ulcer treatment, some type of  healing shoes may be necessary, beforeregular shoes can be worn. These include custom sandals (open toe); heat-moldable healing shoes (closed toe); and post-operative shoes.

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  – External shoe modifications – This involves modifying the outside of the shoe in some way, such as the shape of the sole, or adding shock-absorbing or stabilising materials.

• – Orthoses or inserts – An orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthoses or inserts, are commonly prescribed for patients with diabetes, including a special total contact orthosis.  It is made from a model of your foot, and offers a high level of comfort and pressure relief.
• – Custom-made shoes – 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.

Taking good care of your feet means making sure you have the right foot wear. Whether you have been recently diagnosed, or have had diabetes for many years, proper footwear can help prevent serious foot problems. Be sure to talk to your physician or podiatrist about the type of shoes, modifications, and orthoses that are right for you.

What Are Orthotics?

Orthotics are devices that are worn to correct foot and ankle problems non-surgically. Shoe inserts are placed on the sole of the shoe. They are used to treat conditions that include metatarsal, sesamoid pain, flat feet, and plantar fasciitis. There are many different kinds of inserts, from soft, to quite rigid. Some come in predetermined sizes or contours, while others need to be custom-molded to an individual’s specific foot shape.

                              Your feet mirror your general health . . . cherish them!