Patient Education

Diabetic Shoes

What is diabetes?

Diabetes is a condition in which your body is either unable to produce insulin (a hormone that helps the body process sugar), or your tissues don’t respond to the insulin that’s produced. This leads to too much sugar in the blood, which, in turn, can damage blood vessels, nerves, kidneys, the heart, the eyes, and the feet.

Because of nerve damage to your feet, it may be difficult for you to feel when you’ve done something like step on a small piece of glass or stubbed your toe. And, poor circulation means that injuries or infections may take a long time to heal. So, preventing injuries and irritations to your foot is an important part of avoiding serious complications. Selecting proper footwear is, in turn, the first step in avoiding injuries and irritations. (Lots of first steps in podiatric care…)

What to look for in a shoe

Say you’re going off on a shoe-shopping expedition. The end of the day is the best time to go shoe shopping, since that’s when feet are at their largest. (They’re all stretched out from the rigors of the day. And aren’t expeditions best when done at sunset, anyway (or thereabouts)?) Fortunately, there’s no need for jeeps or hard-hats in this expedition (although they never hurt), but you should be on the lookout for experienced shoe-fitters. Whenever you go shoe shopping, be sure to have your feet measured to get the best fit (since even when you’re an adult your feet may change over time), and be sure to let the clerk know that you have diabetes. Let the clerk fit the shoes for you, then walk about in your shoes for a bit (5-10 minutes should work) to make sure they’re comfortable immediately. Take them off and check your feet (or have the clerk check for you) for any signs of redness. (Redness indicates that there’s undue pressure in an area.) If there is redness, then keep on searching; those shoes are not for you.

Look for shoes that are made of leather, suede or canvas, since these are soft, flexible, breathable materials (leather uppers are best). In fact, you may find the best fit with modern running or walking shoes. (The New Balance brand walking shoe is often an excellent choice.) The widest part of your foot should match the widest part of the shoe (and it goes without saying really that the width of the shoe should easily accommodate the width of your foot). Because your feet are such a pleasing shape, you should pick a shoe that fits the outline of your feet quite well. In short, they should be snug, but not tight. Heels should give a wide base of support. (These are not high heels, folks, which are basically like walking on a nail head.) And the toe box of the shoe should offer plenty of room. Pick shoes that have about 3/4″ of space between your big toe and the inside of the shoe. Make sure that the toe box is high enough to accommodate any toe deformities, such as hammertoes. (Just like most people, toes prefer habitations with plenty of space.) Also, feel free to reach inside the shoe and feel it to make sure there are no ridges, wrinkles or seams that could cause irritation to your foot. You want a smooth lining. (You’ll also want to check your shoes for foreign objects (like little rocks or-ugh-spiders) each time you put them on.)

Once you have diabetes, it may be necessary to give up some types of shoes, simply because they either expose your feet to danger, or because they themselves may cause too much pressure or irritation to your foot. Definitely give up high heels. They offer little or no support and put your feet in horribly awkward (and damaging) positions (kind of like the worst high school bully ever). Also avoid sandals, especially the kind with thongs between the toes, as well as slippers (which offer very little protection), or any kind of shoe with open toes or heels.

Once you get your new shoes home, be sure not to wear them more than two hours at a time at first, until your feet are used to them. (This does NOT mean, however, that you need to break your shoes in. Your shoes should never be uncomfortable, and should fit well from hour one.) As the days pass, you’ll be able to increase the time you wear your new shoes for an hour longer each day. And, these shouldn’t be the only shoes you wear. It’s best to rotate your footwear about every five hours so that you change the pressure points on your feet (and thus avoid the development of ulcers). Have one pair for morning, one for the afternoon hours, and one for evening.

You’ll also want to get your shoes checked out by your podiatrist. He or she knows what can cause problems to diabetic feet, and can check your shoes to be sure they’re made well, fit you properly, and will not cause irritation to your foot.

If you’re having trouble finding shoes in the store that fit you properly, or if your podiatrist recommends it, you may be able to get shoes that are developed specifically for diabetics. In fact, your podiatrist may be able to prescribe lab-made shoes that are designed to fit your feet in particular (which should make you feel extra special, of course). Special shoes for diabetics are often covered under insurance plans, or Medicare.

Socks and stockings

Because they offer another layer of protection and padding, you should really wear socks or nonbonding stockings with your shoes. However, don’t wear socks or stockings made of 100% synthetic material. Instead, use 100% cotton or cotton blends. Avoid wool entirely during warm months, and only wear it in the winter if you’re sure it won’t irritate your skin. (You may not be able to feel itchiness in your feet, but your skin will still react to it, and it might cause serious problems.) Socks shouldn’t be too thick or bulky, either, since that would put too much pressure on your feet.

Avoid seams in stockings or socks at all cost. Such seams may seem innocent (seams in general aren’t known for their threatening appearance), but they can cause irritation to your feet, and may even trigger an ulcer. Same with holes or mended areas: these make for lumpy socks, or socks with edges that’ll rub your skin the wrong way. If your socks have holes in them, get new ones. And don’t wear dirty socks. They’re kind of smelly and, again, can cause irritation to your foot. Wear clean socks, and change them daily.

If all of this seems like too long a list to keep track of, there are, in fact, socks made especially for diabetics. You can always ask your podiatrist about recommended brands.