The
most common cause of diabetic foot ulcers (DFU) is trauma injury. Individuals with DFU were five times more
likely to have been wearing improperly fitting shoes (Nixon et al., 2006). Common problems of poorly fitting shoes are
inadequate shoe length, width of the toe box, and internal seams (Healy, Naemi,
& Chockalingam, 2013). Diabetic
neuropathy prohibits normal sensation of the feet. Increased pressures, calluses, and sores can
occur with repeated use of improper footwear.
DFUs are most likely, to be located in the plantar foot areas.
The goal of therapeutic shoes is to
reduce pressure in high-risk sites, such as the plantar region and locations of
prior DFUs. Therapeutic footwear can be obtained off the shelf or custom
made. Certain aspects should be
considered when deciding on appropriate footwear such as foot deformities,
prior DFU, and activity level. Foot
deformities make off-the-shelf shoes challenging to fit and may respond better
to custom- made footwear. Individuals at
high risk for DFUs should consider custom-made shoes. Specific design features of all therapeutic
footwear should include a rigid rocker bottom and custom insole (Healy, et al.,
2013).
Although therapeutic footwear is
considered an essential intervention in reducing the incidence of DFUs, patient
compliance is low. Footwear must be
regularly worn to be an effective preventative measure. Aesthetics of diabetic footwear was reported
as a factor of low compliance (Williams & Nester, 2006). Many diabetics do not regularly wear
prescribed shoes because they are considered less attractive. Additionally, some individuals do not
purchase therapeutic shoes because of increased cost. However, high-risk diabetics on Medicare qualify
for shoes and insoles through the Therapeutic Shoe Bill, as well as through
many insurance companies (Lawrence, Fontaine & Kim, 2013).
Google Images
Regular use of diabetic footwear has
been shown to reduce pressures and protect the foot from external trauma (Apelqvist
& Larsson, 2000). In addition, regular
footwear use limits behaviors of walking barefoot or wearing socks or slippers,
which can put feet at risk for damage.
Feet should be examined daily for injury, kept dry, and regularly change
shoes and socks, especially if high wear is noted. Diabetic footwear use can prevent DFUs and
potential amputations and is an essential preventative tool.
Video
1: finding and wearing
good diabetic shoes
Google Images
References
Apelqvist, J. & Larsson, J.
(2000). What is the most effective way to reduce incidence of amputation
in the diabetic foot? Diabetes and Metabolism Research and Reviews,
16, S75-S83.
http://dx.doi.org/10.1002/1520-7560(200009/10)16:1+<::aid-dmrr139>3.0.co;2-8
Healy,
A., Naemi, R., & Chockalingam, N. (2013). The effectiveness of footwear as
an intervention to prevent or to reduce biomechanical risk factors associated
with the diabetic foot ulceration: A systemic review. Journal of Diabetes and its
Complications, 27(4),
391-400. http://dx.doi.org/10.1016/j.jdiacomp.2013.03.001
Lawrence, A., Fontaine, J. L., &
Kim, P. J. (2013). Preventing the first or recurrent ulcers. Medical Clinics
of North America, 97(5), 807-820. http://dx.doi.org/http://dx.doi.org/10.1016/j.mcna.2013.05.001
Nixon, B. P., Armstrong, D. G.,
Wendell, C., Vazquez, J. R., Rabinovich, Z., Kimbriel, H. R., ... Boulton, A.
M. (2006). Do US veterans wear appropriately sized shoes? The Veterans
Affairs shoe size selection study. Journal of The American Podiatric
Medical Association, 96(4), 290-292. http://dx.doi.org/10.7547/0960290
The Foot and Ankle Center. (2013,
October 27). Finding & wearing good diabetic shoes [Video file].
Retrieved from https://www.youtube.com/watch?v=mAwgdX5VxGc.
Williams, A. E., & Nester, C. J.
(2006). Patient perceptions of stock footwear design features. Prosthetics
and Orthotics International, 30, 61-71. http://dx.doi.org/10.1080/03093640600574425
