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. Medical shoes, prescribed by a podiatrist, may be unnecessary (unless you have a history of uncontrolled blood glucose levels or a history of foot complications, such as ulcers), 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., C.D.E, founder of EnJOY Life! Health Consulting. Here's how to find shoes that feel good on your feet.
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 Scott, 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, D.P.M., 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. 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, so although you may have been a size 8 all your life, 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:
• Shop in the afternoon. Your feet swell throughout the day.
• Try before you buy. You may wear a size 9 in one brand and a size 11 in another. One foot may even be larger than the other.
• Don't shop alone. Have a shopping companion to help you fit and tie shoes.
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 and provides room for cushioning inserts.
5. Insole cushioning: Ample padding minimizes pressure on the foot's sole. (Inserts can give any shoe extra cushion.)
6. Adjustable closure: This accommodates any swelling.
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 high 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 prescribe the footwear, verifying 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. The prescription will cover one pair of shoes each year, as well as inserts or shoe modifications.
If you don't have Medicare, check your insurance plan and flexible spending account guidelines to see if therapeutic shoes are covered.