Therapeutic footwear

What are therapeutic shoes?

Persons with diabetes who have been diagnosed as being at increased or high risk for foot troubles require therapeutic footwear. The signs that a person with diabetes is at increased risk for foot problems include: loss of feeling (neuropathy); loss of circulation (peripheral vascular disease); foot deformity and prior history of diabetes related foot problems.

Therapeutic footwear has vital role in maintaining healthy feet. Therapeutic shoes are actually safety gear much like a hockey helmet is to a hockey player. These shoes are specifically designed to help prevent the formation of ulcers and other foot problems.

The most important part of the shoe is the fit. The make or style of the shoe is not as important as the fit. People with diabetes and feeling loss or neuropathy in the feet cannot feel their feet well enough to judge the shoe fit. In fact people with neuropathy have a tendency to prefer shoes that are too small in order to "better feel them". Poor fitting shoes can result in serious damage to the feet especially those feet with decreased feeling (neuropathy).

What is a shoe prescription?

A shoe prescription outlines the features that will best protect your foot from diabetes related problems. The importance of proper fit cannot be stressed enough and is first and foremost in any shoe prescription. Accommodative is a word commonly used to describe shoes. This means that the shoe is soft and giving and adjustable. Often it is necessary to put custom soft insoles in the shoes. The insoles take up room so the shoe needs to be of sufficient volume. High volume is a term used to describe a shoe with extra room and or depth. The volume is especially important if there are deformities such as hammertoes. The shoe must be large enough to fit the foot without being too big. Shoes that are too big are just as bad as shoes that are too small because they can slip and rub sores.

In addition to a high volume accommodative shoe some people will also require certain changes or modifications to the shoe. Rigid soles mean that the sole does not bend. This is usually combined with a roller sole. A rigid roller sole is like the rocker of a rocking chair. It does not bend and allows the foot to roll off the sole when walking. Rigid roller soles are used to decrease the pressure beneath the metatarsal heads (bones behind the toes) when walking.

The shoe insoles are equally important as the shoe. The idea behind the insoles is to have a soft material that distributes weight evenly over the bottom of the foot so that one area does not take up more weight than another area. This is called total contact insole. Usually the insoles are custom made from a cast impression of the feet. If part of the foot has been amputated then a fill is added to the insole. The fill improves the insole fit and prevents the foot from sliding.

Custom shoes are used for those who have a lot of deformity or swelling and cannot fit into conventional shoes. The shoes are custom made from a cast impression of the feet. The shoe can be adjusted as needed.

The shoe features and prescription are all secondary to the fit because unless the shoe fits properly it will not work well. Poor fitting shoes can cause serious harm. Persons with diabetes who are at increased risk for foot troubles should discuss shoe requirements with their healthcare provider. The healthcare provider should be able to recommend a reputable store that is used to fitting high-risk feet and can make the necessary shoe adjustments.

Timothy P. Kalla, D.P.M., F.A.C.F.A.S.