Footwear Basics for Patients with Diabetes

Whether a patient with diabetes is using the appropriate footwear will depend on the degree of risk for ulceration and/or the presence of active or recently healed ulceration. Patients who lack protective sensation and who have a history of foot deformity, ulceration, or amputation of any part of the foot should be referred to a podiatrist for an evaluation for special shoes or orthotics.

Patients who still have protective sensation and no history of foot deformity or ulceration generally do not need custom shoes. Following criteria for appropriate footwear, however, can help the patient remain ulcer-free. For a proper shoe fit, the person should be standing when measured for shoes. The ball of the foot (metatarsal heads) should correspond to the widest part of the shoe. The shoe must not cause discomfort or skin irritation; in studies, shoe-related repetitive pressure has been associated with ulceration.

The following are characteristics of ideal footwear for any person with diabetes:

* Laced shoes offer maximum adjustability.

* Calfskin offers flexibility and breathability.

* Secure-fitting heels avoid friction.

* Wedge soles offer greater support than a separate heel and toe.

* Cushioned crepe soles provide traction and comfort.

* Heels should not be higher than 1 inch.

* Pointed-toe shoes should be avoided; a wide toe box is best.

* Maintain 1/2-inch between the longest toe and the end of the shoe.

* The shoe should bend easily at the ball of the foot.

* The shoe should have adequate arch support.

It is best to consult with a specialist, such as a pedorthist or a podiatrist, before making a recommendation.