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If you are looking for diabetic shoes you most likely have some questions or concerns about where to start and what to look for. This quick guide will arm you with answers to these common questions:
• What is Peripheral Neuropathy and what are its effects on the Diabetic Foot?
• Why are proper Diabetic Shoes important for people with diabetes?
• What are the 12 key features to look for in Diabetic Footwear?
• Who are the medical professionals that specialize in diabetic foot care?
• Where can I go to be fitted for diabetic shoes?
Diabetes, also known as Diabetes Mellitus, is a serious chronic condition of metabolism resulting in high blood glucose. The high level of blood glucose is the result of a lack of either insulin secretion or insulin action or in some cases both. Diabetes is the fourth largest cause of death in the USA with more than 200,000 people dying each year from this disease. Diabetes, if left untreated, can cause blindness, heart attacks, strokes, kidney failure and amputations.
Foot disease is the most common complication of diabetes that leads to hospitalizations accounting for up to 20% of admissions, with 15% of diabetics developing a foot ulcer during their lifetime.
Ulcers usually occur as a result of a loss of nerve function as a protective sensation in the foot which known as peripheral neuropathy. The loss of the protective sensation in the foot, often called in medical terms an insensate foot, coupled with a foot deformity and peripheral arterial disease places the foot at a very high risk for ulceration. If an ulcer fails to heel, infection can lead to gangrene and ultimately amputation.
Nearly 100,000 lower foot amputations are performed each year related to diabetes. Although over 10 million people in the United States have been diagnosed with diabetes it is estimated that only half of the total diabetic population have actually been diagnosed which puts the real number at 20 million plus. About 10% have Type 1 diabetes or juvenile onset diabetes where the body does not produce any insulin where a daily insulin injection is needed to stay alive. The other 90% have type 2 diabetes or adult onset diabetes where the body in unable to make enough or properly use insulin.
Adult onset diabetes is primarily a result of a poor diet and where a sedentary lifestyle prevails.
Diabetics have to be very careful with what is worn on their feet, as often is the case, that where peripheral neuropathy is present the foot is rendered insensate and the body’s protective system that alerts the body that something is not right- fails.
For a diabetic that is overweight being able to inspect their feet on a daily basis can be difficult. A typical scenario where a problem evolves could be described as follows. A small stone or pebble lodges in a shoe. The insensate foot does not detect that it’s there. The stone causes a callus or a small wound. If the wound is not felt or observed it progressively gets worse and leads to an ulceration which in turn can lead to an amputation if left untreated and gangrene develops.
So a shoe designed for diabetics in the first instance has very few seams, stitching, rough edges and are soft and smooth and generally minimize the likelihood or risk of trauma to the foot caused by the shoe. In the second instance, the diabetic shoe is deep enough, often termed “ extra depth” to accommodate the diabetic foot where swelling or edema is a factor over the course of the day. In general terms, the foot is smaller at the start of the day when you put your shoes on and larger at night when you take your shoes off. For a diabetic, a diabetic shoe design should enable a shoe to adjust accordingly and be deep enough to accomodate a diabertic insert.
Diabetic inserts are accommodative inserts designed to evenly distribute weight across the bottom or plantar surface of the foot. By doing so, the insert helps alleviate any pressure points that could cause a callus that could lead to a breakdown of the skin and ultimately ulceration and possibly and eventual amputation. To evenly distribute the weight the insert needs to be in 100% contact of the plantar surface of the foot so that the foot is cradled to minimize movement of the foot inside a shoe and the sheer forces caused by that movement and other trauma caused by ill fitting shoes. For diabetics, how the shoe fits is critically important and having the correct insert is a big component of the fit.
Peripheral neuropathy is a condition that affects the nerves outside of the brain and spinal cord that occurs when the peripheral nerves are damaged. One of the most common causes of neuropathy is diabetes. The condition causes weakness and numbness with pain usually in the hands and feet. The pain is described as stabbing, burning or tingling.
Peripheral neuropathy affects the nerves responsible for transmitting sensory information such as pain, temperature and touch from the extremities like hands and feet to the brain. When these nerves are damaged or impaired, individuals may lose sensation or experience abnormal sensations in their limbs. As a result peripheral neuropathy can result in the following symptoms.
Less awareness of injuries, wounds, cuts, blisters or sores can mean they become more severe or infected.
Neuropathy can affect the blood vessels leading to poor circulation and reduced blood flowing limiting the ability for essential nutrients and immune cells to reach the site of the wound and slowing the healing process.
Neuropathy can affect the sweat glands leading to dry and cracked skin which is more prone to injury as it lacks the natural lubrication and elasticity of healthy skin.
Nerve damage can also limit the body’s immune response making it harder to fight off infections and promote healing in wounds.
Neuropathy can lead to the formation of foot ulcers which are slow healing, can become chronic, and are at a higher risk of infection that, if not treated, can lead to a foot amputation.
Neuropathy can affect muscle function in the extremities that can affect gait and increased pressure on specific areas of the feet increasing the risk of developing calluses, corns and pressure sores as well as the risk of falling.
Appropriate diabetic is critically important in managing manage the various foot-related complications associated with diabetes.
Diabetic shoes are designed with extra cushioning and support to reduce pressure on the feet to minimize the risk of calluses, blisters and ulcers.
Diabetic shoes should have a seamless interior without protruding seams that can cause friction and irritate the skin causing skin damage.
Wider and deeper toe box to provide enough room for foot deformities like bunions or hammer toes which are common for people with diabetes.
Neuropathy can affect balance. Diabetic shoes should be wide through the midfoot to improve stability and reduce the risk of balance issues and falls.
Diabetic shoes should have easily removable insoles so that diabetic inserts can be used to evenly distribute the weight bearing across the plantar surface of the foot to reduce pressure points and the risk of ulceration.
Diabetic shoes should be wide enough and deep enough to accommodate orthoses if needed for improved ankle stability or other conditions like foot drop for example.
Diabetics who may have peripheral neuropathy are at risk for factors that can lead to ulceration and possibly amputation. Diabetic shoes and inserts are designed to help reduce the risk of skin breakdown and evenly distribute weight bearing across the sole of the foot.
However, in order to be considered Diabetic Footwear, certain design criteria need to be met. The shoe needs to accommodate the foot so there is plenty of room in the toe box. The insole needs to be thick and removable to accommodate a diabetic insert and the shoe also needs to be available in full and half sizes and in extra-wide widths.
Soft, preferably seamless, upper material to minimize rubbing and abrasion.
Sretchable or moldable upper for customized accommodation for forefoot deformities.
Wide deep toe box to provide plenty of room for toe deformities.
Full and half sizes and multiple widths to ensure a proper fit.
Extra depth with removable insole for inserts or orthotics.
Adjustable closures to accommodate swelling that may occur over the course of the day.
Touch closures for easy on and off for people with limited flexibility or range of motion.
Stable and wide midfoot for improved balance and reduce fall risk.
Lightweight to aid with improved gait and reduce fatigue.
Toe clearace at the front of the shoe to to reduce the risk of tripping.
Delayed heel strike ensures a cushioned entry into the step and also reduces the risk of stumbling.
Machine washability to maintain optimal shoe hygiene.
Doctors of Podiatric Medicine (DPM) who specialize in the diagnosis, treatment and prevention of foot and anke disorders including those related to diabetes. They are often the primary healthcare providers for diabetic foot care and can offer routine foot examinations, treatment of foot ulcers, wound care and can provide guidance on proper footwear and foot care products. Podiatrists can prescribe and supply under Medicare’s Therapeutic Shoes for Persons with Diabetes program for patients that meet certain criteria for coverage.
For more information on Podiatry visit https://www.apma.org/
Medical doctors who specialize in the treatment of endocrine disorders including diabetes. They play a vital role in managing the patient’s blood sugar levels which is crucial for preventing complications including those affecting the feet.
For more information on Endocrinology visit https://www.aace.com/
Specialize in the diagnosis and surgical treatment of blood vessel disorders which can be particularly important for individuals with diabetes as vascular issues can affect blood flow to the extremities.
For more information on Vascular Health visit https://vascular.org/
Address structural and mechanical problems in the foot and ankles that may lead to diabetic foot issues. They perform surgeries such as corrective procedures for foot deformities or bone fractures.
For more information on Orthopedics vist https://www.aaos.org/
Wound care specialists, also known as wound care nurses or physicians, are healthcare professionals trained in the assessment and treatment of complex wounds. They can be essential for managing and healing diabetic foot ulcers.
For more information on Wound Care visit https://www.wocn.org
Diabetes educators, often nurses or dietitians, provide education and guidance to individuals with diabetes, helping them manage their condition effectively, including proper foot care practices.
For more information on Diabetes educators visit https://www.diabeteseducator.org/
These specialists design and provide custom orthotic devices and footwear to accommodate specific foot conditions and promote proper foot mechanics.
For more information visit https://www.abcop.org/
Physical therapists can help individuals with diabetes improve their strength, balance, and mobility, which can reduce the risk of falls and injuries.
For more information visit https://www.apta.org/
In cases where neuropathy is a significant issue, neurologists may be involved in the diagnosis and management of peripheral neuropathy, which can affect the feet and lead to complications.
For more information visit https://www.aan.com/
Dermatologists may be consulted for skin-related issues, such as fungal infections or dermatitis, which can impact the feet of individuals with diabetes.
For more information visit https://www.aad.org/
If possible, it is important for diabetics to be fitted for diabetic footwear professionally. If the shoe does not fit correctly complications can occur and quickly become serious. This is why diabetic shoes and diabetic inserts must be fitted and dispensed by someone qualified in order to be covered by Medicare. Some of the medical professional associations listed above have directories of providers.
www.letswalk.com is a directory of foot health care professionals who are qualified and familiar with the challenges of fitting patients with diabetes. Some providers are qualified to fit shoes and inserts under Medicare’s Therapeutic Footwear for Persons with Diabetes program. Call for an appointment and ask if your local provider accepts your insurance should you meet the criteria for coverage.
Well that about wraps it up for this guide on diabetic shoes. You will hopefully now be in a better position to understand how to go about getting the right shoes to help manage your diabetes concerns.
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