What are diabetic shoes?
People ask me all the time. What do you do for a living? “My company makes diabetic shoes” is what I normally tell them.
My wife has heard the spiel a hundred times and winces every time someone asks. She knows what’s coming next. “What? I didn’t even know diabetics needed special shoes”. Usually I get a dig in the side which is a warning for me to change the topic of conversation at the first opportunity, but it never ceases to amaze me that people are intrigued. It’s usually because most people know someone who is diabetic, most often an elderly family relative.
It’s all in the numbers. Data from the National Diabetes Statistics Report released just last month cited that a whopping 9.3 % or 29.1 million people in the USA had diabetes. Two years prior in 2010 it was 25.8 million and 8.3 %. So the situation is not getting better, it’s getting worse. So if approximately one in eleven people in the US have diabetes, for most families, the likelihood is that someone close to them has diabetes - which is why I get the dig in the side. I am on strict orders from she who must be obeyed not to talk about diabetes in social gatherings, but when pressed, these are the questions people usually ask me.
The most common one is: “why do diabetics need special shoes?”
It’s not a connection that people typically make with diabetes, but foot disease is the most common complication of diabetes that leads to hospitalization, it accounts for up to 20 % of admissions.
Fifteen percent of diabetics will develop a foot ulcer during their lifetime and one in five of those ulcerations will lead to an amputation.
So limiting the risks of cause for a foot ulcer reduces the risk of amputation. Studies have shown that inappropriate footwear fitted poorly to a diabetic foot is a common cause for ulceration. Primarily it is due to the foot being insensate or lacking the ability of feeling caused by peripheral neuropathy where there is a deterioration of the nerves in the foot? “What??” It’s best explained this way. If you have a poor fitting shoe, or maybe get a blister from a new pair of shoes you feel it, take your shoe off and adjust the fit, maybe add a band aid. Diabetics can’t feel that there is something causing trauma and that’s where the damage starts. So a diabetic shoe is designed not to cause trauma, or at least minimize the risk of trauma. Most importantly, diabetics need to have their footwear fitted correctly.
The follow up to that is “so what makes a shoe a good diabetic shoe?” or “what’s so special about a diabetic shoe?”
Diabetic shoes should have plenty of room so that the foot is not cramped in the shoe or where the foot rubs on the shoe. Internal seams are a big “no no”. Shoes designed so that the shoe can adapt during the course of the day as the foot gets bigger (most peoples feet swell over the course of the day – you should always get fitted for shoes later in the day) are a good idea. My company, Pedors Shoes believes that shoes designed using a seamless heat moldable short stretch material in the forefoot work particularly well. The shoe can be easily modified by a Certified Pedorthist to accommodate the needs of a particular foot.
Diabetic shoes should have a closure so that the shoe fits the foot and the foot doesn’t slide in the shoe. An extra depth shoe that has room for an accommodative insert enables the foot to be cradled in the shoe which eliminates the sheer forces caused when the foot moves inside a poorly fitted shoe that can cause trauma to the sole or plantar surface of the foot.
The next question is usually “where do you go to get diabetic shoes”
I always recommend that if there’s a Certified Pedorthist in your area you should visit them. They are the experts in fitting diabetics with shoes and the Pedorthic Footcare Association can help you find one near you. The Pedorthist will evaluate your specific needs and choose the appropriate footwear for you and most importantly make sure the shoe fit is correct. Remember most often the diabetic foot is insensate so the diabetic can’t necessarily determine if the fit is right as they can’t feel in the foot.
The final question is almost always without exception, ‘”how much do they cost”
This one always gets me because I want to say, “well, how much is your foot worth to you?” but of course I don’t. But it stands to reason that if you knew before beforehand that by wearing a pair of diabetic shoes it could save an amputation you wouldn’t care how much the shoes cost. But I guess it’s a natural question to ask of any item for sale.
If the diabetic patient is covered by Medicare and meets the criteria for being considered at risk, then Medicare covers up to 80% of the cost of the shoes and diabetic inserts with the patient responsible for the 20% co-pay. More Patient Information on Medicare’s Therapeutic Shoes for persons with diabetes can be found on the Pedorthic Footcare Association’s website
For private pay, bear in mind that when you go to see a Pedorthist to get fitted for diabetic shoes you are getting not only the right pair of shoes for you but also the benefit of his knowledge and fitting service. It maybe that you need a custom molded shoe that could cost several hundred dollars or it may be that an off the shelf shoe will work just fine.
By the time I’ve gone through my spiel I’m black and blue from the kicks and digs, but I always explain to my wife afterwards that “honey they asked me so I told them” and I get that wry smile that says everything without saying anything at all.
The personal views and ideas of Stephen O'Hare, President of Pedors Shoes in no way reflect the views of the Pedors Shoe Company, the staff, friends or family members - especially his family members.