Ask 10 people what they look for in a pair of shoes, and you may well get 10 different answers. But ask 10 podiatrists what they recommend in shoes for people with diabetes, and you’ll probably get about the same answer 10 times, with “good fit” near the top of most lists.
People with diabetes are at high risk of developing both impaired circulation to the feet and nerve damage in the feet. Impaired circulation causes wounds on the feet to heal more slowly, raising their risk of becoming infected. Nerve damage can cause loss of sensation in the feet, which means a person may not feel heat, cold, or pain in his feet. He may not notice that his shoes are rubbing or pinching or even that he is walking on small objects such as paperclips that have fallen into his shoes.
The combination of impaired circulation and nerve damage sets the stage for foot ulcers. When you add ill-fitting shoes to the mix, the risk of developing an ulcer goes even higher. But finding shoes that fit well is not impossible, and they don’t have to be ugly, either.
Characteristics of a good shoe
Many people with diabetes can wear off-the-shelf shoes with no modifications. However, people who have foot deformities such as bunions, hammertoes, or Charcot joint (a form of joint breakdown) may need special inserts or specially made therapeutic shoes. In addition, people who have certain diabetes complications, such as a previous ulcer, and who have Medicare Part B may qualify for therapeutic shoes or inserts paid for in part by Medicare. (For more on this, click on “Medicare Therapeutic Shoe Program.”) Talk to your health-care provider about whether you need customized shoes or inserts or whether you can safely wear unmodified shoes.
Assuming you can wear off-the-shelf shoes, here are some shoe characteristics to keep in mind when shopping for and trying on shoes. (For a labeled diagram, click on “Anatomy of a Shoe.”)
Toe box. The toe box is the part of the shoe that covers the toes and the ball of the foot. It should be long enough so that the toes don’t hit the front end of the shoe, spacious enough so that the toes can wiggle a little, and wide enough so as not to pinch the ball of the foot. However, it should not be so wide that the foot slides from side to side. A toe box made of breathable materials, such as leather or cloth, allows sweat to evaporate and helps keep feet drier throughout the day. Perforations in leather shoes make them even more breathable.
Seams (where two pieces of material are stitched together) are stiffer than uncut materials and can be irritating if they rub against the feet. For this reason, people with loss of sensation in their feet or with very delicate skin may be better off choosing shoe styles with no seams in the toe box. Manufacturers commonly reinforce the toe box with plastics or fiberboard to make the area more durable. These materials can also be a source of friction, especially for people who have hammertoes or other changes in foot shape that cause the toes to rub against the top of the shoes.
To avoid purchasing a shoe with a toe box that could irritate your feet, feel inside the shoes with your hand for stiff or scratchy seams or any rigid, well-defined structure. If you can feel any of these potential irritants, put the shoe back and try another model.
Tongue. The tongue should be wide enough and padded enough so that the laces don’t dig into the top of your foot. Some tongues have two slits in the middle through which you can thread the laces. Doing so helps hold the tongue in place so it does not slip to one side or the other.