When he was diagnosed with diabetes in 1990 at age 23, Patrick Marshall was not all that surprised. His father had diabetes; so did his grandfather. He knew that exercise was key to keeping his blood glucose in check. So he started a walking routine that, along with a healthy diet, helped him to get his diabetes under control.
Even so, 20 years after his diagnosis, Marshall began to have nerve damage and loss of feeling in his legs and feet. Still, he kept walking regularly. Then, one day, as he was drying off after a shower, he noticed what looked like a boil on the ball of his left foot. “At first I thought, ‘Oh, this will go away,’” he recalls. “But after 2 or 3 days, it only got worse.”
Marshall went to the doctor, who told him the bump on his foot was actually an ulcer that had become infected. And it was spreading. If he’d waited any longer, his doctor said, he would’ve had to have gotten his foot amputated.
Fortunately, the doctors only had to remove a small bone in one of his toes. But to prevent another dangerous sore, Marhsall’s doctor referred him to a foot doctor, Katherine M. Raspovic, DPM, who fit him with custom-made shoes and inserts to protect his feet. “It’s funny how one thing -- picking the right shoes -- can make all the difference,” she says.
What Difference Do Shoes Make?
Even though diabetes has become a widespread problem (more than 9% of Americans have it), many people, even those who live with the disease, don’t fully understand what it can do to your feet.
When it’s not controlled, it can cause nerve damage and loss of blood flow, both of which can lead to a loss of feeling in the feet. That means that if there’s a stone, coin, or even a wadded up sock in your shoe, you wouldn’t feel it rubbing against your skin. Over time, it could create a blister or sore that could become infected.
Even worse, nerve damage can cause your feet to change shape. “Your toes start to bend and curl, squishing together in shoes that are too tight,” Raspovic says. “You should never put on a shoe and feel discomfort and say, ‘Oh, I’ll break this in.’”
If the Shoe Fits
So what’s the “right” footwear for people with diabetes? No matter what you wear or where you get them, your shoes and their inserts should do these four things:
- Relieve pressure on your foot
- Reduce shock on the bottom of your foot and limit how much it moves from side to side inside the shoe
- Support and stabilize any foot or toe deformities
- Keep your foot joints from moving
Raspovic says you should buy shoes with plenty of room in the toe, as well as over the instep and under the ball of your foot. Width is also important. The widest part of the foot should be in the widest part of the shoe. It should also be easy to adjust in case your foot swells.
She also suggests choosing shoes with extra volume for inserts. Or get them custom-made. Many foot doctors (called podiatrists) can do this by taking a cast of your foot. If not, they can refer you to a company that will.
And even if your doctor sends you home with a custom insert, don’t think it’s one- size-fits-all. “You can’t necessarily get your insert and go to the mall and buy a shoe,” Raspovic says. “It won’t be made properly to accommodate, and probably won’t fit in a pair of heels or stilettos.”
The Long Run
Foot problems due to diabetes are long-term, like the disease itself. You don’t grow out of them. Even if your blood sugar is under control, Raspovic says you should check your feet every day. You should also keep your toenails trimmed, wash your feet daily, and wear shoes and socks at all times.
And, she says, you should get to know your foot doctor so you can stay on top of the issue and catch problems early.
Marshall did, and he says he’s glad he found out he needed custom footwear before it was too late. “I can’t stress enough the importance of people with diabetes making an appointment with their podiatrists,” he says. “Now I’m able to get around as normally as any other individual. There’s no cap on my walking distance. I can do anything.”