When you have diabetes, over time the nerves to your feet can become less sensitive. The resulting numbness and reduced ability to feel pain is called sensory neuropathy. This loss of ability to feel pain in your feet can lead to callouses and pressure sores. These injuries are prevented in healthy feet because pain is felt before there is much damage. Pressure sores can lead to ulcers and then infection, which are the major causes of foot amputation in persons with diabetes.
Check your feet daily. Examine the tops, sides and bottoms of your feet. Don’t forget to check between your toes! Look for cuts, blisters, redness and swelling. Use a mirror to assist you in checking the bottoms of your feet. If a cut, blister, redness or swelling does not improve after one day, contact your doctor. Your doctor, diabetes specialist, or nurse should check your feet at least annually. Your health professional will assess the general condition of your feet, the blood supply to the feet, and how well your feet respond to touch.
Footwear plays a major role in the prevention of foot damage. If you lose feeling in your feet, you are not able to feel that your shoes are too tight. The pressure of your shoe against your foot will pinch the skin, causing the skin to ‘blanche’ or turn white where your shoe is too tight. This blanching is evidence that the skin is receiving less blood supply, and leads to callous formation or pressure sores. Even though it may lead to injury, some people who have lost this protective sensation in their feet prefer shoes that are too small in order to better feel the shoe on their feet.
Get shoes that fit correctly! Properly fitted shoes are designed to meet the special needs of your feet. Shoes that fit correctly ensure no extra pressure is placed against the areas of the foot most likely to develop pressure sores and callouses. The area most at risk for pinching and ulcers is around the front of the foot (forefoot). For this reason, your shoe should not touch the ends of your toes. The sides of your shoe should not place pressure on your small toe or the ball of your foot. Specially designed shoes can provide extra depth to accommodate hammertoes (a toe that’s bent and sticks up above its neighbors) and bunions (a deformity at the joint of the big toe), if required. The shoes should not have seams that place pressure on your forefoot. Do your shoes fit correctly? Try the following test.
To see how well your shoes fit, stand with your foot on a piece of paper and trace the shape of your foot. Then take the insole out of your shoe and lay it on top of the tracing of your foot. If the toes of your tracing touch the end of the shoe liner, or the sides of the foot hang over the edges of the shoe liner, then your shoe is too small. When buying shoes, find a shoe supplier with a fitter who knows about the special needs of a person with diabetes. Your shoe should feel loose, especially around the forefoot.
The photo at left shows a shoe suitable for problem feet. This shoe has no seams around the forefoot. The toe box (the depth of the top of the shoe to the sole) is very deep to accommodate hammertoes and ensures that no pressure from the top of the shoe is against the foot. The sole, made from soft rubber, is easy to modify if necessary. Shoes should have a removable liner inside that can be replaced by a custom foot insert. A custom foot insert (orthosis) is recommended if you have reduced feeling or deformity in your foot. Custom inserts reduce pressure on areas of your foot at risk for sores or callous formation.
The shoe pictured on the right can be used to accommodate severe toe deformities. The shoe is constructed with a stretch fabric at the forefoot to allow it to expand around bunions or hammer toes. The Velcro™ closure is not ideal, but may be preferred if you have difficulty putting on and removing your footwear. Again, replacement with custom foot inserts can help to reduce pressure to high-risk areas of the foot.
The shoe in at the left combines the stretch fabric around the forefoot with a wedge type midsole. It is very light in weight and less bulky, but still permits use of custom foot supports. The wedge midsole shape may be preferred if you have worn shoes with raised heels. This shoe looks like regular footwear.
As all footwear can cause problems for the feet, it is important to wear shoes that will protect your foot from injuries that can happen over the course of normal daily life. Avoid wearing bedroom slippers around the house. Do not wear lightweight and soft footwear, as they typically do not have enough protection for your feet. Even dropping a jar on your foot can be serious, especially if you have reduced feeling in your feet and may not be aware of injury. Never walk barefoot. If you have questions about your shoes, bring them with you when you visit your diabetes specialist or have them examined by a qualified foot care expert.
Diabetes can increase the risk of serious foot problems. Preventing pressure sores and callouses by wearing proper shoes can be as important as good blood glucose management. Have your feet assessed by your health care provider so you know if you are at risk of developing pressure sores or callouses. Have your current shoes checked for appropriate fit and replace them with shoes that will protect your feet if your current shoes do not. When buying new shoes, be sure to seek out shoe fitters skilled at meeting the special needs of your feet.