The importance of good shoes for Diabetics

Most people can feel and recognise when their shoes don’t fit, when little toes get squished or bulging bunions threaten to burst through the sides. Take a moment to think about the shoes your wearing now. Can you wriggle your toes freely? How tight are the laces or any straps you may have? What about around the instep – does it match the shape of your foot? And what sort of condition are your shoes in? Are they in their prime or are they ready for retirement?

Wearing shoes that fit correctly is essential to prevent foot problems. Poorly fitting shoes can create pressure areas, blisters, calluses and corns, as well as muscle aches and pain. While many of us can get away with wearing ill-fitting shoes from time to time, people with diabetes must always make sure their shoes fit well. A blister or something as simple a bit of rubbing can become very serious, very quickly.

Diabetes and its complications

About 890,000 Australians currently have diabetes, but estimates suggest this could be up to 1.7 million because many people are unaware they have the condition. Recent figures show that 275 people develop diabetes in Australia every day.

Diabetes can cause a loss of feeling in the feet, known as neuropathy. This occurs due to elevated sugar levels in the body interfering with nerve signals from the feet to the brain. Consequently, the feet can no longer feel pain. This loss of feeling means that the feet are at significant risk of injuries such as corns, blisters or pressure areas. Poorly fitting shoes can cause all of these problems, which in turn can lead to ulceration (a hole in the skin) and possible infection. In the worst cases, foot or lower leg amputation may be required.

When you consider that foot problems are the most common reason for hospital admissions in people with diabetes, it becomes very clear that footwear has an important job to do. Any loss of feeling, limited joint motion, foot deformities such as bunions, flatfeet and claw toes, as well as the risk of ulceration and amputation, should be considered when choosing footwear.

Choosing a ‘good’ shoe

The benefits of ‘good’ footwear are well known anecdotally, but few scientific studies have actually assessed ‘good’ shoes. What the research does show is that therapeutic footwear reduces pressure and friction significantly, whilst supporting the feet and keeping the wearer comfortable. Consequently, therapeutic footwear improves healing time of foot ulcers and decreases the risk of reulceration.

But choosing the right shoe is a difficult task for many people. Feet are often slightly different sizes, with estimates showing that 70 per cent of people have one foot longer than the other. Width can also vary. Shoes should be fitted to the longer foot and getting help from an experienced footwear professional is best.

Several studies have shown that people who have painful feet, ulceration, loss of feeling or poor circulation often wear incorrect footwear. A 2006 US study measuring shoe size against foot size in a high-risk population of 440 people, found that only 25 per cent of subjects wore appropriately sized shoes. Other research from the UK indicates that ill-fitting shoes may cause foot ulcers in people with diabetes and may exacerbate other complications in people without diabetes. In fact, evidence shows that people with diabetes and loss of feeling or ulceration are far more likely to be wearing poorly fitting shoes.

Having some knowledge about your risk status, the shape of your feet and your footwear options will go a long way to preventing foot problems.

Hard to fit feet

There is some excellent footwear available, even for hard to fit feet. Custom-made therapeutic shoes are the most effective because they can accommodate deformities and custom-made insoles, tailoring specifically to the wearer. However, custom-made shoes are often expensive, which can be a limitation for some people. Many people also see therapeutic footwear as ugly, which may be a factor in not wearing these shoes as part of treatment.

Extra width and depth shoes are available over the counter, are less expensive and possess many of the benefits of custom-made shoes. Shoes like the Dr Comfort range can reduce pressure and if fitted correctly, will still accommodate and protect the foot.

Regular footwear is often not appropriate for people who are high risk or have hard to fit feet, as it may not offer adequate support, protection or pressure relief. Research shows that people with a history of ulceration are significantly more likely to reulcerate if they wear their own shoes than if they wear therapeutic footwear every day.

Suggested reasons for non-compliance with good footwear include lack of education, aesthetics and the perception that the home environment is safe. A 2001 US study found that high-risk patients are less likely to wear prescribed footwear around the house, which may be a major factor in reulceration.

Talking shoes

Education and communication between patients, shoe store attendants and healthcare professionals about shoe fit is essential to ensure best results. Having a regular footwear assessment could help improve comfort and prevent foot problems.

Footwear choices must be sensible, practical and considered. Communicating with a podiatrist, other suitably qualified health professional and a footwear specialist, is essential to ensure good choices are made.

Knowing your foot type, its needs and what shoes suit you best will help prevent problems from occurring. For those people who are high risk or have hard to fit feet, choosing shoes does not have to be a painful experience, but it should be a collaborative one. Getting it right is just so important.