GET THE NEED-TO-KNOW: CHOOSING THE RIGHT FOOTWEAR CAN BE TRICKY LIVING WITH DIABETES!

by Dr. Kate Marsh

Earlier this year, new guidelines on footwear for people with diabetes were published. While the guidelines are aimed at health professionals working with people with diabetes, if you are living with diabetes it’s important that you know about the recommendations made within the guidelines.

So what are these recommendations? They are broken into three categories:

1. Recommendations for everyone with diabetes;
2. Recommendations for individuals with a high risk of foot ulcers; and
3. Recommendations for people with a foot deformity or previous ulcer. 

Recommendations for everyone with diabetes

Choose the right shoes. This means shoes that fit well and which protect and accommodate the shape of your feet. They should be the right length, width and depth and the toe area needs to match the shape of your forefoot and toes. Enclosed rather than open heel shoes are also recommended as these provide additional support and prevent injury to the heel area.

Don’t forget your socks. The guidelines recommend that people with diabetes always wear socks within their footwear, to provide additional protection for the feet and reduce rubbing. Socks should be made mostly from natural materials (to avoid excess moisture), be seamless and should not have elasticised tops.

Understand the importance of having the right footwear. The guidelines emphasise the need for all individuals with diabetes (and their family and caregivers) to be aware of the importance of having and wearing the right footwear, to help in preventing foot complications, including ulcers.  Having regular foot checks is also essential.

Recommendations for those whose feet are at risk of ulceration

• Obtain footwear from a trained professional. They can help you to choose the right shoes to fit and accommodate your feet. This is particularly important for those with loss of feeling in their feet, as this can make it more difficult to choose shoes that fit well.
• Wear the right footwear at all times. This includes indoors as well as outdoors so that the feet are always protected and supported.
• Always check your shoes before wearing them. This is important to ensure there are no foreign objects inside which could damage your feet.
• Always check your feet after wearing shoes. Check to make sure there are no signs of pressure, trauma or ulceration each time you wear any footwear. 

Recommendations for those with foot deformities or previous ulcers

• Consider medical grade footwear. If you have a foot deformity or a previous ulcer, regular off-the-shelf shoes are unlikely to fit and protect the feet properly and you may need special footwear. Prescribed by a trained professional, these can be made to accommodate any foot problems you might have and to reduce pressure in certain areas.
• Review your prescribed footwear regularly. Both your feet and your footwear can change shape over time so the guidelines recommend that any footwear you are prescribed (including custom-made orthoses or insoles) should be reviewed every three months to ensure they still fit, protect and support the feet.

Lastly, if you have an active foot ulcer, the guidelines don’t recommend particular footwear but emphasise the need for an offloading device (such as a special cast or boot) to reduce pressure in the area and help the ulcer to heal. These new guidelines can help you and your healthcare team to choose the right footwear for your individual needs.