You won't likely see an orthopedic pump on the Paris runways, but shoe companies are making progress in footwear design that respects the concerns of people with diabetes (PWDs). Here's how to find shoes that feel good on your feet.
Who Needs Special Shoes?
Do you need so-called diabetic shoes? You may not if your blood sugars are controlled and you have no history of foot wounds or decreased sensation.
Medical shoes may be unnecessary, but all people need footwear that fits. "Well-fitting doesn't just mean you wear a certain size, but that your shoes are not too loose or too tight anywhere on your foot. That helps prevent you from forming blisters and calluses, and protects you from trauma outside of the shoe," says Joy Pape, R.N., CDE, WOCN, CFCN, founder of EnJOY Life! Health Consulting.
People who have uncontrolled blood glucose levels or a history of foot complications, such as ulcers, may need therapeutic shoes.
"For high-risk patients, protective shoes and insoles are a mainstay of preventing foot ulcers," says Lawrence Lavery, D.P.M., M.P.H., foot researcher and professor of surgery at Texas A&M Health Science Center College of Medicine in Round Rock, Texas. "These patients need to use the type of protective shoes prescribed by their podiatrist."
Therapeutic shoes must meet certain requirements developed by the U.S. Food and Drug Administration to qualify for Medicare Part B coverage. "The shoe has to have extra depth, it has to accommodate custom inserts that are put into it, it has to have the protective features that diabetic shoes need, like a protective toe and protective heel, and it needs to fit well," says Eddie Cross, director of the Crocs, Inc., medical division.
Commercial shoes don't need to adhere to any strict guidelines. Comfort and fit often take a backseat to fashion. Heels, soles, fasteners, fabrics, and other factors can rub your feet the wrong way.
Foot researcher Lawrence Lavery cautions against buying medical shoes from shopping malls or traditional shoe stores because staff members lack specialized training, and people with limited foot sensation may not be able to feel for proper shoe sizing. A podiatrist can unveil underlying issues, such as circulatory problems or arch flattening, which are tricky to observe during self-exams.
Also, what used to be a good-fitting shoe for you may have changed. According to Cordell Atkins, P.T., DPT, CWS, CDE, CPed, manager of the Intermountain Diabetic Foot Clinic at Intermountain Healthcare's The Orthopedic Specialty Hospital in Murray, Utah, you may experience minor changes in your feet throughout your lifetime. "Patients with diabetes tend to get longer and wider feet as they age due to arch flattening," he says. "Realize that your body changes and so can your shoe size. You may have been a size 8 all your life, but now you could be a size 10." A podiatrist can help determine your size and recommend an adequate shoe.
Here's how to shop smarter for shoes that fit:
Shoe Shopping Secrets
It may seem elementary, but it's important that your shoes are larger than your feet. To quickly check for proper shoe sizing and shape, try our favorite foot-tracing trick:
Several features ensure that a shoe is more likely to accommodate your foot. Here's what to look for:
1. Spacious toe box: This area around the toes should be wide and nonconstrictive. Crowded toes can lead to poor circulation and foot wounds.
2. Breathable upper: Bacteria and infections thrive in warm, damp environments. Leather and many synthetics help deflect moisture.
3. Hard outsole: Hard rubber soles protect your feet from sharp objects.
4. Wide footbed and deep interior: A roomy footbed allows for foot swelling that occurs every day. A spacious interior provides room for cushioning shoe inserts.
5. Insole cushioning: Ample padding minimizes pressure on the foot's sole. Comfort tip: Off-the-shelf or prescription inserts can give any shoe extra cushion.
6. Adjustable closure: This accommodates any foot swelling that occurs throughout the day.
7. Low arches: If you have flat feet, avoid shoes with arched insoles, which can cause uncomfortable pressure.
8. Seamless interior: Raised seams can cause friction and irritation. Lined or reversed seams are also OK.
9. Closed design: A completely covered foot is protected from pebbles and other debris, which can be tough to detect if you have decreased sensation in your feet.
10. Low heel: High heels create pressure points on the balls and heels of the feet that can lead to calluses and ulcers. Wide, square heels less than 1-2 inches in height are best.
Don't forget the socks! "Diabetic" socks aren't needed for healthy feet but do offer padded soles and gentle elastic. Opt for synthetic fibers, which wick perspiration away from your skin.
People with diabetes who qualify under Medicare Part B can receive aid for up to 80 percent of the cost of specialty shoes, which often retail for more than $100 per pair. To receive the discount, your doctor must prove that you have diabetes, have a history of foot complications, are currently being treated under a comprehensive diabetes care plan, and exhibit a need for medical footwear as a result of your diabetes.
If Medicare approves your request, you may receive reimbursement for one or two footwear options each year. The first includes one pair of commercial therapeutic shoes and three pairs of shoe inserts. The second option covers one pair of custom-molded shoes (including inserts) and two additional pairs of shoe inserts. Custom-molded shoes are covered only if commercial shoes cannot accommodate your feet.
If you don't have Medicare, check your insurance plan and flexible spending account guidelines to see if therapeutic shoes are covered.