When the shoe fits

Everyone needs good footwear. But when you have diabetes, shoes are about more than just fashion

Happy feet!

It’s estimated up to 50 per cent of people with diabetes have peripheral neuropathy, a type of nerve damage that affects your ability to sense pain and hot or cold temperatures. And, as many as half may have no symptoms. “Normally, if you have a blister, you feel it and stop wearing a certain shoe. But if you don’t have sensation in your feet, you may keep wearing the shoe and walking on the area that’s sore,” says Monara Dini, a podiatrist in the Center for Limb Preservation at UCSF Medical Center. Those points can turn into foot ulcers and cause problems. The right shoes can go a long way towards keeping foot complications at bay.

Since shoes break down over time, take inventory every six to 12 months. How do your feet feel in the shoes? Have any parts of the shoe worn down? Telltale signs shoes need to go: they do not feel as supportive, the heel caves to one side or is worn down, the forefoot shows excessive wear, and the lining is thinning or tearing. Walking and jogging shoes should be retired at 480-800km, or at least every five months. When you’re ready to hit the store, keep these tips in mind.

Look for foot-friendly features

Start with a good supportive sole. “Cushioned outer soles, like EVA soles on running shoes or Vibram soles on some dress shoes, are shock absorbent,” says John Giurini, chief of podiatry at Beth Israel Deaconess Medical Center.

Opt for shoes made from breathable material, such as fabric or soft leather, and with laces or Velcro, which let you adjust the fit. A padded tongue and collar (the rim around the shoe) will cushion your feet and ankles. If you have hammertoes or Charcot joint, look for extradepth shoes to accommodate these structural foot changes. Giurini recommends steering clear of rigid leather or rubber shoes, and slip-on styles such as loafers.

Walking or athletic shoes are a good choice for everyday wear. For vigorous activities such as hiking, it’s even more important to find a shoe that fits well and gives protection to your feet and ankles. “There’s a lot of up-and-down movement when you hike, so it’s important to stop and check your feet regularly,” advises Dini.

While wearing sandals and flip-flops may seem like the perfect way to stay cool during warmer months, opentoe styles don’t safeguard your toes and feet. “The straps can also put pressure across the foot and lead to sores,” says nurse and certified diabetes educator David Miller.

Try them on

There’s only one way to tell if a shoe fits – try it on. Since your feet change shape and size over time, have them measured by a certified shoe fitter or pedorthist each time you buy new shoes (you can find one at pedorthics.org.au). Shop at the end of the day when your feet tend to be bigger. And, if you have inserts or orthotics, don’t forget to bring them!

When you try on a pair of shoes, stand up. “You should have about 2.5cm of room at the end of your toes,” says Karen Andrews, an associate professor in the Department of Physical Medicine and ➤

Rehabilitation at the Mayo Clinic. “Make sure your foot has space to spread and the shoe is wide enough to accommodate your foot without creating pressure points,” she says, but not so much space that your foot slips side-to-side. Feel inside the shoe, too. Seams or bulky linings can bunch up and cause hotspots.

Don’t aim for snug

With neuropathy, the decreased sensation in your feet can make it hard to determine if a shoe fits. “Oftentimes, people choose a shoe that’s too small. They perceive the snug feeling as a good fit, but it can be too tight,” says Giurini. A narrow toe box can squish your toes and cause corns, calluses and other injuries.

Pay attention to your socks

Socks provide an extra layer of protection between your shoe and skin, reducing the risk of blisters. Melissa Joy Dobbins, dietitian and diabetes educator, recommends going for seamless, moisture-wicking styles that keep your feet dry and don’t pinch around the calves or ankles. Look for breathable material such as cotton, wool or acrylic, especially for exercise. A little extra padding on the heel and ball of the foot also helps.

Break them in slowly

It’s exciting to get a new pair of shoes, but don’t wear them all day right out of the box. “Wean into wearing new shoes the first week,” says Andrews. Start with an hour the first day and add 30 minutes each day. Once you get to three hours with no hotspots, you’re good to go. Not sure your shoes are right for your feet? Your podiatrist can evaluate them.

Do you need ‘diabetesfriendly’ shoes?

If your blood glucose is in your goal range and you don’t have a history of foot ulcers or neuropathy, stick with shoes from your local store. If you have a history of serious diabetes-related foot disease, therapeutic shoes may help. They’re designed to redistribute the forces applied to your feet when you walk, reducing your risk of foot ulcers.

Find your fit

FRANKiE4 A healthier option for on-trend shoes, created by a physiotherapist and podiatrists. Ziera For more than 70 years, it has created superior shoes for support, comfort and stability. Hush Puppies World-class comfort in casual, yet stylish, shoes, perfect for any day. Bared Shoes Designed by a podiatrist, these shoes are available for both narrow and wide feet, providing comfort all day long.

Not too loose, not too tight – look for just right!