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Foot Care Q&A: Part 2

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

Dr. Scheffler: The shoes aren’t diabetic. People with diabetes don’t all need special shoes, although if they have one of the three problems I mentioned earlier — neuropathy, peripheral arterial disease, and deformity — or calluses, having the special shoes is helpful. Many insurance companies, as well as Medicare, will pay for shoes if the patient meets certain criteria. Sometimes just a running shoe, with cushioning and a high toe box, is adequate.

People with diabetes who actually run need a good running shoe. Go to a specialty store that sells shoes to marathon runners and has a good shoe fitter, not just a part-time salesperson. Brands of running shoes I recommend for people who don’t have [foot] problems are Brooks and Asics.

Dr. Wu: Only people with loss of protective sensation need to wear diabetic shoes. These are extra-depth shoes with a special diabetic insert in them, made with softer material than most orthotics. They help protect the area. Extra-depth shoes can also accommodate custom diabetic inserts from your foot doctor.

2. Do I need to wear diabetic socks? Are there any particular brands or types you recommend?

Dr. Smukler: These are socks that do not have a seam, and I seldom recommend them because I see such a limited benefit to the population I serve.

Dennis Janisse: It depends on many conditions that can potentially exist. For example, do you have severe swelling, loss of sensation, extreme sweating or lack of sweating, or an amputation? Yes, if you have these problems, you could benefit from proper socks, but they really have to be dispensed by someone that understands you and your problem. The broad term “diabetic socks” means nothing today.

Dr. Scheffler: I recommend socks that are not cotton, socks with products that wick perspiration away from your skin and don’t bind. Look for acrylic socks; some have copper or silver that kill bacteria and fungi. “Diabetic socks” are usually the ones without seams, so they won’t rub, and some have a wider top, which is helpful if your legs are large or swollen. Some brands I recommend are Aetrex and Dr. Comfort.

Dr. Beauchamp: Diabetic socks are usually made of materials that are not offensive to skin integrity. They can be virtually seamless in an effort to reduce friction and pressure on delicate skin areas.

Dr. Wu: Diabetic socks are for people who have lost protective sensation. They have no seam. The bottoms and toes should be white so you can see if there is any bleeding or if a foreign object is sticking to the foot or shoe.

3. What are insoles and orthotics? Do I need them?

Dr. Smukler: Orthotics are customized inserts for your shoes. Insoles are what you find in the store. Orthotics are used when you need to change the way your foot functions. Do you need them? Not if you don’t have a problem with your foot. If you have a problem with the function of your feet, then yes. Your podiatrist can recommend whether or not you need this. A lot of people want me to put orthotics in their high heels to make them work. I tell them I treat their foot problem, not their shoes’ problems. When it comes to insoles, sometimes buying a cheap cushion for your shoe is all you need.

Dr. Beauchamp: Orthotics are devices constructed from an image of an individual’s foot to correct particular mechanical deformities or biomechanical forces throughout the gait cycle of the individual as he walks. These images may be generated via computer topography of the foot or plaster or fiberglass negative casting techniques. Correction can be made to these images, thereby reducing the deforming forces that may be causing the foot pain. Insoles tend to be over-the-counter pads that add cushion or gel to the shoe. Some are even antimicrobial in nature. They do not offer corrective support but can add comfort to a pair of potentially uncomfortable shoes.

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