People with diabetes are prone to having foot problems, often because of two common complications of diabetes - nerve damage (neuropathy) and poor circulation. Neuropathy is loss of feeling in the feet, taking away the ability to feel pain and temperature, so you may not feel when an injury or irritation occurs to the feet. Poor circulation in the feet reduces the ability to heal a wound, making it easy for a wound to get infected. Having diabetes increases the risk of developing foot problems, causing small problems to become serious ones like amputations.

The majority (85 percent) of persons who get an amputation first had an ulcer, so significant effort should be made to prevent a foot ulcer. An ulcer under the foot can develop in a couple of hours. Neuropathy, trauma and foot deformity are the most common reasons why ulcers develop in the feet.

Poorly fitting shoes are the most common cause of trauma to the feet which increases the risk of amputation. One study in Barbados identified high risk footwear and behaviors that increased the risk of amputation three times. These included going barefoot in the garden, wearing sneakers without socks to work or to town and wearing rubber thong sandals (flip flops) daily or fashion footwear (high heels) once weekly.

Shoes for people with diabetes are very important. As the normal protective sensation of the feet is lost, proper shoes become even more critical. Shoes serve to protect the feet and balance and distribute pressures evenly throughout the foot or transfer pressure away from high risk areas. The primary goal of therapeutic footwear is to support the foot and prevent foot injury including strains, ulcers, callouses, or even amputations for patients with diabetes. Shoes for diabetic patients are designed and specially made to accommodate conditions such as neuropathy (numb feet), poor circulation and foot deformities (bunions, hammertoes, etc).

Diabetic shoes decrease the risk of foot sores (ulcers) which can be caused by friction and pressures from shoes. Wearing therapeutic diabetic shoes have been proven to protect the feet and help prevent ulcers and amputations. Diabetic shoes, sometimes referred to as therapeutic or orthopedic shoes, are specially designed shoes, intended to reduce the risk of skin breakdown and ulcers in diabetics.

The shoes are deeper (extra depth) and wider than regular shoes. The shoes are made of soft leather with good arch support. Before the shoes are sold, the podiatrist will measure the diabetic patient's feet. The shoes are then ordered from a company that makes and sells diabetic shoes. In some cases, when the feet have several deformities and need extra protection, the podiatrist may order custom-made shoes which will accommodate the special needs of the feet. One of the most important ways to ensure proper shoe fit is to have the feet measured regularly.

Insoles are the inserts that go in the shoe. The diabetic shoes and custom-molded inserts work together to help diabetics avoid foot injuries and improve mobility. Diabetic insoles are special prescription insoles and are ordered with diabetic shoes.

Insoles provide extra cushioning and prevent friction between the shoes and the feet. The insoles should be changed every four to six months, or when they appear worn out. The shoes can last for a year or longer based on how much they are worn.

When to wear diabetic shoes?
All diabetics with neuropathy, poor circulation and foot deformity (change in the shape of the feet) should wear diabetic shoes to protect their feet. The shoes MUST be worn all of the time, anytime there is weight on the feet, indoors and outside. If the diabetic had a toe or part of the foot amputated they will also need prescription insoles with a "filler"(protective part of the insole that is shaped like the missing part to take up the space where the toe or part of the foot was amputated).

Swimming and bike riding are good overall exercises that do not put stress on the foot. Sporting activities, such as running, tennis, baseball, and other sports that produce high stress on the feet should be avoided entirely.

The diabetic patient should check his/her feet at least once a day for injury and ulcerations. Wearing shoes without insoles or socks can be as bad as walking barefooted. The podiatrist will measure the diabetic's feet and order the shoes to fit and accommodate for any deformities or special needs. Diabetic shoes are good quality and usually last for quite a while. They should be examined regularly and replaced if they are worn or in poor condition. Wearing diabetic shoes is an important way to prevent injury, ulcers and amputation of the feet.

o For more information email us at foothealth242@gmail.com or visit www.foothealthfacts.org. To see a  podiatrist visit Bahamas Foot Centre on Rosetta Street or call 325-2996 for an appointment, Bahamas Surgical Associates Centre on Albury Lane or call 394-5820 or Lucayan Medical Centre, Freeport, Grand Bahama or call 373-7400 for an appointment.

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