Diabetic+Living-Summer_2019

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.