People who suffer from diabetes can have problems with circulation, nerves, immunity, and deformity. Occasionally one or more of these may exist as an isolated issue but often people suffer from more than one at the same time.
- Circulation: People with circulation problems don’t have as much oxygenated blood supplying their feet as other individuals and therefore have difficulty healing any wounds.
- Nerves: Those who have nerve problems can develop a blister and oftentimes not even know it is there until they take off their shoes.
- Immunity: Some individuals with diabetes have a diminished response of their immune system. Because of this, they can get an infection from a cut or blister more easily and have more difficulty treating it.
- Deformity: People who suffer from diabetes can have collapse of the arch of their foot or other deformities which makes the foot more difficult to place into off-the-shelf shoes because of the risk of blisters developing over areas
of high pressure.
Proper footwear is therefore very important for people with diabetes. Your foot and ankle orthopaedic specialist can help you choose proper footwear and recommend shoe modifications to protect your feet.
How do special shoes work?
The shoes often are prescribed by foot and ankle orthopaedic specialists and fitted by a group of professionals called pedorthotists. The shoes may be designed to have a very stiff sole and rocker bottom foot to decrease the forces sent to the ball of
the foot. They also may have a bar or wedge applied to the sole to even out the weight distribution on the foot. Shoes will be designed to prevent any seams that are inside the shoe from rubbing against the foot.
There can be several benefits to wearing custom shoes:
- Relieve areas of increased pressure. Any area where there is too much pressure on the foot can lead to skin breakdown. Footwear should help to relieve these high-pressure areas and therefore reduce the occurrence of related problems.
- Reduce shock and shear. The footwear should decrease both the amount of vertical pressure, or shock, on the bottom of the foot, as well as reduce the horizontal movement of the foot within the shoe, or shear. Reducing the shock and shear can reduce or prevent blistering and wounds.
- Accommodate, stabilize, and support deformities. Deformities resulting from conditions such as collapse of the arch, loss of fatty tissue, hammer toes and amputations must be accommodated. Many deformities need to be stabilized to
relieve pain and decrease the risk of progression of the deformity.
- 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.
How will I know if I need a special shoe?
If the shape of your foot has begun to change, or you've noticed skin breakdown, redness or swelling, you should make an appointment with your foot and ankle orthopaedic specialist for an evaluation. That being said, shoe wear is just one area of potential
benefit and this evaluation would take into account your other medical problems and available treatment options. Depending on the findings, shoe inserts, wedges, custom arch supports, or special shoes may be recommended. When there is concern for
ulceration and infection, your foot and ankle orthopaedic specialist may recommend other treatments first, including special types of casts and skin care and possibly even surgery.
What are special shoe options?
Many diabetics need special footwear prescribed by a physician. Prescription footwear includes:
- Healing shoes. Immediately following surgery or as part of treatment of an ulcer, some type of shoe may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe)
and post-operative shoes.
- In-depth shoes. The in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4- to 1/2-inch of depth throughout the shoe, allowing extra volume to accommodate
any needed inserts or orthoses, as well as deformities commonly associated with a diabetic foot. In-depth shoes also tend to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually
- External shoe modifications. This involves modifying the outside of the shoe in some way, such as modifying the shape of the sole or adding shock-absorbing or stabilizing materials.
- Orthoses (singular: orthosis) or inserts. An orthosis is a removable insole which provides pressure relief and shock absorption. Both off the shelf and custom-made orthoses or inserts are commonly prescribed for patients with diabetes, including a special total contact orthosis,
which 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.
How long do special shoes typically last?
Similar to the regular shoes that you have worn in the past, with the exception that occasionally the upper portion of the shoe may be made from a type of leather that stretches better such as deer hide. This softer leather can be stretched or will stretch
as you continue to wear it and it adjusts itself to the shape of your foot. Unfortunately, this comes at a cost since this type of leather is less durable. Independent of the type of leather used, if the shoe is beginning to break down, it should
again be evaluated by the pedorthotist or other individual who fitted you or with your foot and ankle orthopaedic specialist.
When should I wear these shoes?
In general, these shoes are designed to be worn on a daily basis whenever you are on your feet. That being said, if your foot does not have significant deformity or loss of sensation, brief periods of time in a different type of shoe may not be so risky
that it cannot be considered. Talk to your foot and ankle orthopaedic specialist to discuss how often you should be in your diabetic shoes. They will work with you to make sure you can be as active as possible.
Are special shoes heavier than normal shoes?
There are many styles of special shoes. They may look different than regular shoes and sneakers, but usually aren’t heavier.
Something doesn’t feel right about my special shoes. What should I do?
If the shoes don’t feel right, you should speak with the professional who fitted or made them or your foot and ankle orthopaedic specialist, as changes to the footwear may be needed.
Do I need custom shoes?
Rarely. Shoes that can be ordered and then fitted, often with some arch supports, will do the job most of the time. However, if custom shoes are necessary, a pedorthotist can often assist you in this process.
Original article by James Jastifer, MD
Contributors/Reviewers: F. Ray Nickel, MD; David Macias, MD
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