Proper footwear is an important part of an overall treatment program for people with diabetes, even at the earliest stages of the disease. If there is any evidence of neuropathy, wearing the right footwear is crucial.
As a general rule, people with diabetes should choose shoes that:
- Accommodate, stabilize, and support deformities, such as Charcot Foot, loss of fatty tissue, hammertoes, and amputations. Many deformities need to be properly supported to relieve pain and avoid further damage.
- Limit motion of joints. Limiting the motion of certain joints in the foot can decrease inflammation, relieve pain, and result in a more stable and functional foot.
- Reduce shock and shear. A reduction in the overall amount of vertical pressure or shock on the bottom of the foot is desirable, A reduction of horizontal movement of the foot inside the shoe is also important to reduce shear.
- 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 reduce the occurrence of skin complications.
Many diabetics need special prescription footwear.
- Custom-molded shoes. When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.
- External shoe modifications. In these cases, the outside of the shoe is modified in some way, such as adjusting the shape of the sole or adding shock-absorbing or stabilizing materials.
- Off loading shoes. Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn.
- In-depth shoes. An in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4-inch to 1/2-inch of depth throughout the shoe. This extra volume accommodates inserts, or orthotics, as well as deformities commonly associated with a diabetic foot. In-depth shoes are usually designed to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.
- Orthoses or shoe inserts. Also known as orthotics, an orthosis is a removable insole which provides pressure relief and shock absorption. Both pre fab and custom-made orthotics or shoe inserts are commonly recommended for patients with diabetes and offer a high level of comfort and pressure relief.