Do you know what to wear on your feet? The right socks and shoes can prevent complications and improve your life with diabetes. Find the footwear that’s right for you.
Why do people with diabetes need good socks and shoes? Diabetes often slows blood circulation to and from the feet. If blood doesn’t flow well from feet to the heart, legs and feet will swell (called edema). If blood gets stuck in veins, it may form blood clots that can travel to your lungs (pulmonary embolism) or brain (stroke), which can be fatal.
Arteries bring blood from the heart to the feet. In poorly controlled diabetes, arteries can be blocked with scar tissue and fat deposits. This is called peripheral arterial disease (PAD). According to the University of California-San Francisco Medical Center, people with diabetes have two to four times the risk of developing PAD compared to those without diabetes.
Endocrinologist Bonnie W. Greenwald, MD, says, “Poor blood flow makes it harder for the body to heal, which increases the risk for skin ulcers and gangrene, or tissue death.” The end result can sometimes be amputation of a foot or leg.
This is where shoes and socks come in. The right footwear can protect feet from injury and infection. It can also improve circulation through the lower half of your body.
Diabetes socks protect feet from injury. According to the medical equipment company Sigvaris, “Most diabetic socks are soft, provide padding on the sole of the foot, and should conform to the foot/leg without wrinkles,” which could irritate the skin. They shouldn’t have anything sharp in them, so they are often seamless or have “flat seams” against the toes or foot.
The Sigvaris site says, “The fibers should wear evenly, instead of leaving thin spots where friction can occur. They should offer moisture-wicking properties to minimize the risk of infection and blisters.”
Diabetes socks protect skin but don’t improve circulation. To push blood out of the feet and calves and back to the heart, you need something stronger.
Compression socks are tightly knit, close-fitting socks that gently squeeze your feet and legs. Some doctors have warned against using them in diabetes, for fear they could squeeze arteries. Recent studies, though, have found mild compression safe and helpful.
A 2012 study followed 18 patients for four weeks. All had diabetes and edema in their calves and feet. They were fitted with stockings and told to wear them all the time they were awake for four weeks. Over the four weeks, their calf and foot swelling came down, and there were no signs of circulation problems.
Compression stockings must fit perfectly. Wrinkles or bunching will defeat the purpose and can irritate the skin. Michelle Huie, founder and president of VIM & VIGR, a company that makes high-end, stylish compression stockings, says her company “uses a sizing chart that looks at shoe size and calf size. We also have great customer service representatives to help people find the ideal fit and fabric.”
If you have trouble or concerns about fit, a doctor, physical therapist, or technician at a medical supply store can help.
Compression socks can be made from nylon, cotton, or wool. They should be made on special machines that guarantee a tight weave. Huie cautions that, “There are lots of brands out there that claim to be compression, but they do not use medical knitting machines, which means the customer is not receiving the full benefits of compression.”
When I was a hospital nurse, compression stockings were white, medical-looking things that yelled “old and sick.” Now you can buy attractive, colorful stocking in various patterns. Look at some choices here.
VIM & VIGR stockings sell for over $30 a pair. Other companies charge from $15–$40, but you have to be careful about quality with a lower-end stocking. Insurance usually doesn’t pay for them, but ask. Yours might be covered as medical equipment, or your Health Savings Account may cover it, if you have an HSA.
Living with compression
Compression stockings need good care, like your feet do. Reid Hospital of Indiana’s site advises washing them every day with mild soap and water. Rinse and air dry. Never put them in a dryer; don’t dry clean. Wash them in a linen bag if you machine wash.
“If you can,” says Reid, “have two pairs. Wear one each day. Wash and dry the other pair.” Stockings wear out and need replacing every 3–6 months to maintain strength. If you have more pairs to alternate, they will last longer.
Putting compression socks on can be a challenge. Put them on in the morning when your feet are least swollen. Wear them all day and take them off at night. They should feel tightest around the ankle and less tight as they go higher.
Most people put them on by rolling them down toward the heel, putting their foot in all the way and rolling and pulling them back up over the leg. A little baby powder or cornstarch on the legs might help. You can see an instructional video here that makes it pretty easy.
This article on Healthline points out, “Good socks won’t help if your shoes are pinching your feet or causing injuries and ulcers.” Be careful to get good-fitting, not tight, shoes. Check inside them with your hands before putting them on, to make sure no fibers, pebbles, or other objects are sticking out. Avoid pointy toes and high heels.
In Diabetes Self-Management, Dorothy Foltz-Gray wrote, “Buy shoes at the end of the day when your feet will likely be a bit swollen. A good choice is athletic or walking shoes, [not vinyl, plastic, or hard leather ones]. Break new shoes in slowly, wearing them only an hour or two a day for the first couple of weeks.” If you’re not sure whether your shoes fit well, perhaps see a podiatrist.
Move your legs
Sitting or standing for long periods leads blood to pool in your calves and feet. Walking or otherwise moving your legs every hour will help the blood flow, improve foot comfort, and prevent complications like strokes.