Diabetic Footwear forms the backbone of diabetic foot care. One must understand that in a diabetic the feet are neuropathic, there are abnormal pressure points and The Arches of the foot may be lost. To add to the problems, the patient is likely to have uncontrolled sugar as well as ischemia which means less blood flow to the feet. All this is a perfect recipe for diabetic foot infections and gangrene ultimately leading to amputations.
In the early stages when neuropathy is just setting in the patient needs to have a regular diabetic footwear which essentially has the following characteristics
micro cellular rubber insoles with established shore values
EVA n Plastozotes are modifications of the above
A counter on the rear aspect
Nontraumatic contours
Velcro or a buckle which should not hurt
the most important thing over here is that the patient should be counselled to wear footwear even at home along with thick cotton socks with the seam on the outside
In case the patient loses his toe, the gap is replaced by a filler. This is essentially a blob of rubber with or without a pad of silicon to it. This is to prevent the change of direction of the other toes to compensate for the loss of a particular toe.
In case of a callus or an ulcer due to a callus, an insole correction is made Whereby the pressure point is offloaded with an attempt to heal the ulcer
in case of ulcers in the front part of the foot which is called forefoot, a front ortho wedge shoe is recommended
in case of ulcers in the heel area, a heel orthowedge shoe is recommended
It is important to remember that footwear should be used at home as well as outside and different pairs should be assigned for the same. Socks are compulsory at all times
For walking or for outdoor activities the standard instructions while buying a pair of shoes is as follows
shoes should be purchased in the evening when the foot is slightly swollen as compared to the daytime
try out a comfortable footwear and ask for one size more
the interior of the shoe should be soft, non spiky and should have no loose ends
the outsole should be rigid
High heel shoes and pointed tight footwear are strictly prohibited