Diabetic Foot Care, Including Diabetic Shoes

Just a little bit of background information

Type II diabetes mellitus, also known as adult onset diabetes, affects over 392 million people worldwide.  The increase in obesity in the United States is a contributing factor for the increase in the number of people afflicted with this disease. As the disease progresses over time, it affects the eyes, kidneys and feet.

Diabetes affects the feet via peripheral neuropathy. Peripheral neuropathy is when the nerves of the feet become damaged. This is caused with either increases or fluctuations in blood sugar levels. As diabetes progresses neuropathy can cause tingling, burning and eventually numbness to the toes and feet. The concern that podiatrists and other medical practitioners have is that if a diabetic can’t feel their feet they may injury or cut their feet and may not feel it. This can then lead to a diabetic foot wound, subsequent infection and possibly even amputation. It is recommended that a diabetic follow up closely by a podiatrist a few times a year for a foot checkup.

Other important factors in relation to diabetes and feet are poor circulation. Peripheral vascular disease, also known as PVD, can cause blockages in the blood flowing to the legs. Someone can have PVD with or without diabetes. A combination of diabetes, neuropathy and PVD can be destructive. If a diabetic has a lack of sensation to the legs, and diminished blood flow to the feet, an open sore can be catastrophic. A diabetic may form an ulceration, which they cannot feel and then with PVD they cannot heal. Due to this it is highly recommended for close follow up for diabetic foot exams.

If I am a diabetic, what are measures I can take to prevent any foot infections?

Besides close follow up by a foot specialist it is recommended for diabetic to do daily foot inspections. By checking one’s feet daily a small cut or lesion can be identified and should be immediately reported to ones physician before an infection sets in. It is also recommended to keep the spaces between the toes dry and the skin on the top and bottom of the foot well hydrated with moisturizer. It is recommended to wear white diabetic socks, where one can spot blood or pus, before even realizing they have a sore. Lastly, wearing comfortable protective diabetic shoes is recommended. Diabetic shoes with heat molded inserts are covered by Medicare and most insurance plans. This can be dispensed during a foot checkup.

What precautions should I take to prevent injuries to my feet due to diabetes?

Washing your feet every day can help prevent serious health problems. Be sure to:

Use lukewarm water and test the temperature with your hand before stepping in to make sure it’s not too hot!

Completely dry your feet after washing, as infections like to form in moist areas such as between the toes.

Soften skin with water-based hand and foot creams as dry and cracked feet often cause infections.  

Do not place moisturizing creams in between the toes. Avoid oil and petroleum jelly as they dry the skin and not hydrate the skin.

Other suggestions include:

If you are a diabetic, controlled by diet or medication, you should never cut your own toenails. All toenail care and trimming of corns or calluses should be done by a podiatrist as recommended by the American Diabetic Association and almost all insurance companies.

Quit smoking as it decreases oxygen and blood flow to the feet.

Don’t cross your legs.

Avoid sitting or standing in the same position for lengthy periods of time.

What types of shoes should I wear?

If you are a diabetic suffering from peripheral neuropathy or circulation problems of the feet it is important to have shoes that are wide, soft, have high toe boxes as well as padded heels and tongues. Patients with reduced sensation or circulation wearing improperly fitting shoes run an increased chance of developing foot ulcerations and infections.

The federal government through Medicare has developed standards for a properly fitting diabetic therapeutic shoe. Shoe manufacturers submit their designs through Medicare for approval as a diabetic therapeutic shoe. For those patients who are diet or medication control diabetics, with symptoms of peripheral neuropathy or circulatory insufficiency, Medicare will pay for one pair of diabetic therapeutic shoe per calendar year as well as three pair of diabetic therapeutic insoles for the shoes.