Keep diabetics healthy from the toes up
Low-cost measures prevent expensive problems
Exercise is an important part of a good diabetes management program. And a safe, effective diabetes exercise program begins with proper shoe fit and style.
"From the standpoint of diabetes education about foot care, shoe fit and selection is probably the No. 1 opportunity for case managers to promote better self-management in their diabetic patients,"says Robert S. Schwartz, CPed, president and chief executive officer of Eneslow, the Foot Comfort Center in New York City. "Diabetic patients with neuropathy receive no feedback from their feet telling them that a shoe is too small or uncomfortable. That's why it is important for case managers to stress the importance of a properly fitting shoe."
Toe room, shock absorption emphasized
Here are the features he says are essential for diabetic patients:
· Shoes should have laces. "A lace-up shoe allows for a more custom fit than slip-on or Velcro tab shoes," he explains.
· Shoes should have three-eighths of an inch of toe room. "With the foot against the shoe's heel, there should be three-eighths of an inch of toe room in the front of the shoe. This allows the foot to elongate and also allows for normal foot expansion due to changes in temperature or activity levels," he says.
· Shoes should hold feet in alignment. "Diabetics must have supportive shoes to hold their feet in alignment. The shoe `counter' is the part of the shoe that wraps around the back to provide stability."
· Shoes should have shock-absorbing soles. "The soles of the shoe should be made of shock-absorbing material. It's also important that the shoe have at least a one-inch heel, so that the shoe is higher in the back than in the front. Women are usually more comfortable with a heel that is one-and-one-half inches."
· Shoes should have removable insoles. "It's great if shoes have removable insoles so that we can easily slip in custom orthotics if necessary. Most people do have one leg slightly longer than another or one foot slightly larger than the other. Orthotics really customize the shoe's fit to prevent little deformities from taking place."
· Shoes should have a high toe box. "The top of the toes should not rub against the top of the shoe. A high toe box prevents the toes from rubbing on the top of the shoe."
Most diabetic foot problems are caused by friction, shear, and misalignment, all of which can be largely prevented with a properly fitting shoe, Schwartz says. He urges case managers to "pay for the cheap stuff and stop waiting for the expensive stuff. Preventive management in the simple form of properly fitting shoes can go a long way to prevent serious disorders that require surgical intervention. An extra-supportive shoe with a high toe box and a little foot care education can help prevent the serious problems that lead to diabetic neuropathic amputations."
A self-management protocol
In addition to a properly fitting exercise shoe, Schwartz recommends that diabetic patients wear a good exercise sandal around the house rather than slippers or shoes. "Exercise sandals have a foot bed that is foot-shaped and are open in the front and back. A good exercise sandal costs anywhere from $30 to $120 and keeps the foot working and functioning," he says. "The sandals force the foot to grip. This means the feet are functioning to keep the shoe on and not being encased. This promotes circulation and is a great self-management protocol for diabetics."
Schwartz recommends exercise sandals made by Birkenstock, Mephisto, Dr. Scholl's, and Finn Comfort. "Tell patients that wearing the sandals gives their foot a workout, and that if they wear the sandals too long in the beginning, they may experience foot fatigue," he cautions.
Case managers also should encourage diabetics to watch for early warning signs that their shoes don't fit properly, he says. "The foot can develop many little deformities that signal poorly fitting shoes." Those include:
· corns and calluses;
· bunions, or knobs on the big toe or base of the fifth metatarsal;
· hammer toes, or toes that claw together and stick up;
· collapsed or fallen arches.
"These conditions are all signs that shoes are too narrow, too short, or fail to provide adequate support," Schwartz says. "These deformities are easy to see. Recognizing them early and changing into a better-fitting shoe can save bigger problems down the road."
[Editor's note: Eneslow, The Foot Comfort Center holds regular educational seminars on proper foot care for health professionals. For more information, contact: Eneslow, 924 Broadway, New York, NY 10010. Telephone: (212) 477-2300. Fax: (212) 477-2156. E-mail: [email protected].]
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