Diabetic+Living-Summer_2019

(Nancy Kaufman) #1
Since shoes break down over time, take
inventory every 6 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 re-
tired at 300 to 500 miles, or at least every
5 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. “Cush-
ioned outer soles, like EVA soles on run-
ning shoes or Vibram soles on some dress
shoes, are shock-absorbent,” says John
Giurini, D.P.M., chief of podiatry at Beth
Israel Deaconess Medical Center.
Opt for shoes made from breathable
material like fabric or soft leather, and with
laces or Velcro, which let you adjust the fit
to your feet. A padded tongue and collar
(the rim around the shoe) will cushion
your feet and ankles. If you have hammer-
toes or Charcot joint, look for extra-depth
shoes to accommodate these structural
foot changes. Giurini recommends steer-
ing clear of rigid leather or rubber shoes
and slip-on styles like loafers.
Walking or athletic shoes are a good
choice for everyday wear. For vigorous ac-
tivities like hiking, it’s even more import-
ant to find a shoe that fits well and protects
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, open-toe
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, RN, M.S.Ed., diabetes care coor-
dinator for Community Health Network
in Indianapolis.

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 abcop.org.) 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 an inch of
room at the end of your toes,” says Karen
Andrews, M.D., 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 accommo-
date 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 hot spots.

DON’T AIM FOR SNUG
With neuropathy, the decreased sen-
sation in your feet can make it hard to
determine if a shoe fits. “Oftentimes, peo-
ple 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,
M.S., RDN, CDE, recommends seamless,
moisture-wicking styles that keep your feet
dry and don’t pinch around the calves or
ankles. Look for breathable material like
cotton, wool, or acrylic, especially for exer-
cise. A little extra padding on the heel and
ball of the foot helps too.

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
hot spots, you’re good to go. Not sure your
shoes are right for your feet? Your podia-
trist can evaluate them.

DO YOU NEED INSOLES?


Bunions, hammertoes, and other changes
to the shape of your foot can create pres-
sure points and sores. Custom inserts can

Balance: WHEN THE SHOE FITS


Finding the Right Fit

20 DI ABETIC LI VING / S UMMER 2 019


be molded around these problem areas
and disperse the shock, allowing the area
to float rather than hit the ground directly.
Ask for inserts specifically designed for
people with diabetes, which provide three
layers of protection and support. “Over-
the-counter insoles could be appropriate
for common conditions like plantar fas-
ciitis or foot or ankle pain, but significant
foot problems usually will require a cus-
tom solution,” says Giurini.

DO YOU NEED


“DIABETES-FRIENDLY SHOES”?


If your blood sugar 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.
Medicare Part B may help pay for
therapeutic shoes and inserts. If you
qualify and have a prescription from a
podiatrist or another qualified physician,
you’ll be fitted by a podiatrist, pedorthist,
or orthotist and receive either one pair of
extra-depth shoes and up to three inserts,
or one pair of custom-molded shoes or
inserts and up to two additional inserts
each year.
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