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How to Choose Footwear

by Roy H. Lidtke, DPM, CPed

What not to buy
Although there are a wide variety of shoes that are suitable for people with diabetes, there are also a few styles that should be avoided. High-heeled shoes fall into this category. High heels put increased pressure on the ball of the foot and place the back of the foot in an unstable position. They also increase shear, or the movement of foot tissues in opposing directions. Shear is a primary cause of calluses, blisters, and ulcers. A suitable heel will be less than one inch in height.

Slip-on loafers are another style that is best left in the store. Because there is very little of the shoe covering the top of the foot, these shoes provide inadequate support. They are also typically made of unpadded, rigid leather, which can be a source of friction.

Sandals that have straps between the toes are unsuitable as well, since the straps can cause irritation.

Shoe size
Having your feet measured each time you buy shoes is an important part of making sure the shoes you select fit your feet. Feet tend to change shape and size over time, so few people can wear the same shoes at age 50 as they did in high school. In addition, many people have one foot that’s larger than the other, so you should have both feet measured. The tool used for determining shoe size is called the Brannock Device. It measures the width, taken across the ball of the foot; the arch length, measured from the heel to the ball of the foot; and the overall length from heel to toe. To get an accurate measurement, stand naturally with your weight divided evenly between both feet. Remember that your feet tend to swell the longer you are on them, so it is a good idea to shop for shoes toward the end of the day.

Ideally, the size for the arch measurement and the size for the heel-to-toe measurement should match. If they don’t, the size is usually based on the longer of these two measurements. But these numbers don’t tell the whole story, because even shoes with the same numerical size can vary in shape, height of the toe box, and overall depth. A person with a very thick foot or with joint changes in the foot may require an “extra-depth” shoe to accommodate the bulk of the foot or special shoe inserts. An expert shoe fitter will measure the height of the foot and the circumference of the foot around the arch, and use these numbers to match the foot with the appropriate shoe.

If you have narrow feet, shoes with wide-set eyelets will allow you to pull the laces tighter, if necessary. If you have wide feet, shoes with closely set rows of eyelets may work better.

A test run
Once your feet have been measured and you have chosen a shoe style, the real test is how they feel on your feet. Make sure you are wearing the type of sock or stocking you normally wear, and don’t forget to also bring any orthotics or inserts you will be wearing in the shoe.

Put on both shoes and attach the laces, buckles, or straps, then stand up. There should be some room, preferably 1/2 inch to 5/8 inch, between the tip of your longest toe and the front of the shoe. Walk around, and make sure that your arch is fully supported and that the break or bend of the shoe is located at the ball of your foot. Check how the width accommodates the ball of your foot — if the upper portion of the shoe is bulging out over the midsole, the shoe is too narrow and you should ask for a larger width. As you walk, note whether your heel moves around in the shoe. Try rising up onto your toes (holding onto something for support) and notice whether the heel slips off the back of your foot. A properly fitted shoe should slip slightly in the heel, particularly when new, but it should not move excessively or slide off the back of the foot. Make sure the sides of the shoe aren’t hitting your anklebones when you stand still or walk. Roll your feet to the insides as if you were trying to flatten your arches, then to the outsides, as if to roll over onto your ankles. The shoe should feel like it is trying to restrict these motions, but it should not feel like it is placing excessive pressure against any one spot on the foot. Walk around the store for as long as you need to make sure the shoe is comfortable and supportive. Shoes should not need to be broken in, stretched, or otherwise modified. If this is suggested, do not purchase the shoes, because they are the wrong ones for your feet.

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Also in this article:
Medicare Therapeutic Shoe Program
Anatomy of a Shoe
Lacing Patterns



More articles on Foot Care



Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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