“Footnotes on Selecting Diabetic Footwear”

There are a lot of shoes out there, but not all of them would be appropriate selections for our diabetic patients.  In fact, selecting improper footwear could actually harm our diabetic patients and lead to diabetic foot ulcers and possible amputations.  Statistics show that 50% of amputations of our diabetic patients are directly related to improper footwear!amputation

Diabetic Wound Certified clinicians need to know how to check the footwear of our patients as well as the staff caring for our patients.  What are we looking for in a shoe for our diabetic patient?  The shoe should offer a firm snug fit.  The heel should be less than 1 inch, the greater the heel the greater the pressure on the ball of the foot and this could lead to callus formation and ulcerations.  The shoe should have laces, buckles or elastic to hold it in place.  When the diabetic is wearing slip on shoes the toes must curl to hold the shoe on and this can lead to calluses on the top of the toes and potential ulceration.  The shoe should have 1cm between the longest toe and the end of the shoe when the patient stands, we don’t want added pressure to the tips of the toes or on the toenails.  The sole of the shoe should be smooth without seams and cushioned to absorb shock and reduce pressure on the feet.  The shoe should be made from a material that “breathes”, avoid plastic and vinyl as they can encourage fungal infections.  The shoe should have a protective function; a closed toe shoe is imperative for our diabetic patient.  Look closely at the patients foot and the shoe – they should be the same shape, pointed toe shoes cause corns, calluses and ulcerations! Be sure the shoe width is appropriate, has a wide toe box that allow toes to move and accommodates any foot deformity.  The heel of the shoe should also be firm, you can check this by holding the sides of the heel of the shoe between your thumb and forefinger, try to push them together, if the heel compresses, its to soft and won’t give the patient good enough support when walking.

We also need to teach our patients and their family members instructions on checking for proper fit of their shoes and how to shop for new shoes.  They should be re-measured each time, shop late in the day, try on both shoes and walk around in them to ensure they are comfortable, be sure there is a thumbs width of space at the end of the longest toe, try the shoe on with the socks they will be wearing, be sure the heel is less than an inch, and be sure the shoe has laces or velcro closures.  If the patient has serious foot problems or deformities they should be referred for specially molded inserts and or shoes.

Following the above recommendations may just prevent a patient from developing a diabetic foot ulcer and an amputation!  Patient and caregiver education is a key factor in preventing diabetic foot ulcers!

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