Diabetes has appropriately been described as a public health problem of epidemic proportions in the United States. More than 25 percent of the estimated 23.6 million people with diabetes in the U.S. will develop significant foot problems.
People with diabetes are prone to peripheral neuropathy and may have essentially no sensation in their feet. As a result, tissues already overly susceptible to poor circulation, infection and skin damage may give no warning when a developing crisis is being exacerbated with every step.
In the diabetic foot, skin breakdown can result from a single high-stress event, such as stepping barefoot on a sharp or blunt object; from ischemia, aggravated by tight-fitting shoes; or, most commonly, from the repetitive moderate stress of everyday walking.
A common outcome is ulcers on the plantar surface under the metatarsal heads. Without aggressive treatment, superficial lesions can quickly degenerate to deep ulcers involving tendon and bone. Further deterioration can yield an abscess, osteomyelitis and ultimately gangrene and amputation. Diabetes is also the most prevalent factor in the development of neuropathic arthropathy, frequently leading to foot and ankle deformities.
The goals of applying therapeutic footwear are to provide even pressure distribution across the plantar surface, eliminate focused stress areas, afford shock absorption and foster proper foot biomechanics.
While foot orthoses can be designed to correct certain deformities, the primary role of special footwear for diabetic patients is to provide an advanced level of protection for the insensate foot.
General considerations for diabetic shoes include low heels, a spacious, rounded toe box, well-cushioned heel and sole, and soft uppers that can mold to the shape of the patient’s foot. Shoes with extra depth throughout are commonly prescribed to allow insertion of a molded foot (FO) or ankle-foot (AFO) orthosis or to accommodate minor deformities. For advanced diabetes and gross deformities, custom-molded shoes or boots are generally necessary. Therapeutic shoes are available in a wide variety of styles and colors.
Inserts And Modifications For Diabetic Shoes
Custom-molded orthotic inserts and special modifications are added to shoes to provide for specific anatomical, functional and protective needs. Inserts are foot orthoses formed to a model of the patient’s foot to protect against focused stresses and to accommodate minor deformities. They are typically made from lightweight-but-durable materials and can be easily removed and replaced when necessary.
Shoe modifications – arch supports, metatarsal bars, rocker bottoms, toe-fillers, heel counters, and heel and sole wedges – are used to relieve pressures under the metatarsal heads, provide advanced protection for the plantar surface and assist full heel-to-toe gait after a partial foot amputation. Special modifications may also be applied to accommodate Charcot joint deformities resulting from diabetes related arthropathy.
When it comes to diabetes management, one size definitely does not fit all. We welcome your inquiries about diabetic footwear and recommendations for individual patients.
LeTourneau Prosthetics offers many different types of footwear for diabetic patients. Please schedule your free consultation to determine your best options. We have offices located in Beaumont, Nederland and Jasper. Many patients also visit us from as far away as Houston and Lake Charles and many cities in between.