Everyone needs good footwear. But when you have diabetes, diabetic footwear is about more than just fashion.
It’s estimated that up to 50 percent of people with diabetes have peripheral neuropathy, a type of nerve damage that affects your ability to sense pain and hot or cold temperatures. And as many as half may have no symptoms. “Normally, if you have a blister, you feel it and stop wearing a certain shoe. But if you don’t have sensation in your feet, you may keep wearing the shoe and walking on the area that’s sore,” says Monara Dini, D.P.M., a podiatrist in the Center for Limb Preservation at UCSF Medical Center. Those pressure points can turn into foot ulcers and cause a cascade of problems. But the right diabetic footwear can go a long way toward keeping serious foot complications at bay.
Since shoes break down over time, take inventory every 6 to 12 months. How do your feet feel in the shoes? Have any parts of the shoe worn down? Telltale signs shoes need to go: they do not feel as supportive, the heel caves to one side or is worn down, the forefoot shows excessive wear, and the lining is thinning or tearing. Walking and jogging shoes should be retired at 300 to 500 miles, or at least every 5 months. When you’re ready to hit the store, keep these tips in mind.
LOOK FOR FOOT FRIENDLY FEATURES
Start with a good supportive sole. “Cushioned outer soles, like EVA soles on running shoes or Vibram soles on some dress shoes, are shock-absorbent,” says John Giurini, D.P.M., chief of podiatry at Beth Israel Deaconess Medical Center.
Opt for shoe fits made from a breathable material like fabric or soft leather, and with laces or Velcro, which let you adjust the fit to your feet. A padded tongue and collar (the rim around the shoe) will cushion your feet and ankles. If you have hammertoes or Charcot’s joint, look for extra-depth shoes to accommodate these structural foot changes. Giurini recommends steering clear of rigid leather or rubber shoes and slip-on styles like loafers.
Walking or athletic shoes are a good choice for everyday wear. For vigorous activities like hiking, it’s even more important to find a shoe that fits well and protects your feet and ankles. “There’s a lot of up and- down movement when you hike, so it’s important to stop and check your feet regularly,” advises Dini.
While wearing sandals and flip-flops may seem like the perfect way to stay cool during warmer months, open-toe styles don’t safeguard your toes and feet. “The straps can also put pressure across the foot and lead to sores,” says nurse and certified diabetes educator David Miller, RN, M.S.Ed., diabetes care coordinator for Community Health Network in Indianapolis.
TRY THEM ON
There’s only one way to tell if a shoe fits— try it on. Since your feet change shape and size over time, have them measured by a certified shoe fitter or pedorthist each time you buy new shoes. (You can find one at abcop.org.) Shop at the end of the day when your feet tend to be bigger. And if you have inserts or orthotics, don’t forget to bring them!
When you try on a pair of shoes, stand up. “You should have about an inch of room at the end of your toes,” says Karen Andrews, M.D., an associate professor in the department of physical medicine and rehabilitation at the Mayo Clinic. “Make sure your foot has space to spread and the shoe is wide enough to accommodate your foot without creating pressure points,” she says, but not so much space that your foot slips side-to-side. Feel inside the shoe too. Seams or bulky linings can bunch up and cause hot spots.
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DON’T AIM FOR SNUG
With neuropathy, the decreased sensation in your feet can make it hard to determine if a shoe fits. “Oftentimes, people choose a shoe that’s too small. They perceive the snug feeling like a good fit, but it can be too tight,” says Giurini. A narrow toe box can squish your toes and cause corns, calluses, and other injuries
PAY ATTENTION TO YOUR SOCK
Socks provide an extra layer of protection between your shoe and skin, reducing the risk of blisters. Melissa Joy Dobbins, M.S., RDN, CDE, recommends seamless, moisture-wicking styles that keep your feet dry and don’t pinch around the calves or ankles. Look for breathable material like cotton, wool, or acrylic, especially for exercise. A little extra padding on the heel and ball of the foot helps too.
BREAK THEM IN SLOWLY
It’s exciting to get a new pair of shoes, but don’t wear them all day right out of the box. “Wean into wearing new shoes the first week,” says Andrews. Start with an hour the first day and add 30 minutes each day. Once you get to three hours with no hot spots, you’re good to go. Not sure your shoes are right for your feet? Your podiatrist can evaluate them.
DO YOU NEED INSOLES?
Bunions, hammertoes, and other changes to the shape of your foot can create pressure points and sores. Custom inserts can be molded around these problem areas and disperse the shock, allowing the area to float rather than hit the ground directly. Ask for inserts specifically designed for people with diabetes, which provide three layers of protection and support. “Over the- counter insoles could be appropriate for common conditions like plantar fasciitis or foot or ankle pain, but significant foot problems usually will require a custom solution,” says Giurini.
DO YOU NEED “DIABETES-FRIENDLY SHOES”?
If your blood sugar is in your goal range and you don’t have a history of foot ulcers or neuropathy, stick with Shoe Fits from your local store. If you have a history of serious diabetes-related foot disease, therapeutic shoes may help. They’re designed to redistribute the forces applied to your feet when you walk, reducing your risk of foot ulcers. Medicare Part B may help pay for therapeutic shoes and inserts. If you qualify and have a prescription from a podiatrist or another qualified physician, you’ll be fitted by a podiatrist, pedorthist, or orthotist and receive either one pair of extra-depth shoes and up to three inserts, or one pair of custom-molded shoes or inserts and up to two additional inserts each year.
HAPPY + HEALTHY FEET
1. Check your feet every day. Look for redness, swelling, blisters, or skin or nail changes. Use a mirror or ask for help if you have trouble seeing your feet.
2. Wash your feet daily. Use warm, not hot, water and dry well after washing, especially between your toes.
3. Keep your toenails trimmed. Your podiatrist can help with this too.
4. Don’t go barefoot. It’s easy to step on something and hurt your feet, so keep them covered, indoors and out.
5. Shake out your shoes. There may be a stray rock (or LEGO!) hiding inside.
6. Visit your podiatrist. Get a complete foot exam annually (or every two to three months if you have neuropathy).