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Role of Custom Orthotics & Footwear in Diabetic Foot Conditions

People who have diabetes can have various complications due to diabetes, and one of them is Diabetic Foot Disease (DFD). A combination of various conditions of the foot, including the problems with circulation, nerves, immunity, and deformity of the foot, is seen in DFD. Occasionally one or more of these may exist as an isolated issue, but often people suffer from more than one at the same time.

  • Circulation: People with circulation problems don’t have as much oxygenated blood supplying their feet as other individuals and therefore have difficulty healing any wounds. Many times, their veins also have difficulty taking the blood back to the heart.
  • Nerves: Those who have nerve problems will have either negative symptoms – they don’t feel anything in the foot, either touch, heat or cold, or vibration, and positive symptoms – pain, tingling sensation, burning sensation, etc. They may also have balance issues.
  • Immunity: Some individuals with diabetes have a diminished response to their immune system. Because of this, they can get an infection from a cut or wound more efficiently and have more difficulty treating it.
  • Deformity:  The muscles in the foot get weaker, and the persons can have a collapse of the arch of their foot or increased arches, hammertoes, or other deformities, causing pain or high pressures in certain areas of the foot.

Proper footwear is, therefore, essential for people with diabetes. Your Podiatric Specialist at FootSecure can help you choose proper footwear and recommend shoe modifications to protect your feet.

How does special footwear work?

The footwear often is prescribed by podiatry specialists and fitted by a group of professionals called orthotists. The footwear may be designed to have a very stiff sole (more commonly people feel that the softer the soles, the better the footwear is, but that is a myth, what is required is an insole, which is hard enough to correct the foot and the gait and withstand the body weight) and rocker bottom foot to decrease the forces sent to the ball of the foot.

They also may have a bar or wedge applied to the sole to even out the weight distribution on foot. Footwear will be designed to prevent any seams that are inside the shoe from rubbing against the foot. 

There can be several benefits to wearing custom footwear:

  • Relieve areas of increased pressure. Any area where there is too much pressure on the foot can lead to skin breakdown. Footwear should help relieve these high-pressure areas and reduce the occurrence of related problems, like calluses, wounds, blisters, etc.
  • Reduce shock and shear. The footwear would decrease both the amount of vertical pressure or shock, on the bottom of the foot, and reduce the impact of horizontal movement of the foot within the shoe.
  • Accommodate, stabilize and support deformities. Deformities resulting from conditions such as the arch’s collapse, loss of fatty tissue, hammertoes, and amputations must be accommodated. Many deformities need to be stabilized to relieve pain and decrease the risk of progression of the deformity.
  • Limit motion of joints. Limiting certain joints’ motion in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot. 

How will I know if I need a special shoe?

If the shape of your foot has begun to change, you have callouses in your foot, or you’ve noticed skin breakdown, redness, or swelling, you should make an appointment with our podiatry specialists for evaluation.

That being said, custom footwear is just one area of potential benefit, and this evaluation would take into account your other medical problems and available treatment options.

Depending on the findings, shoe inserts, wedges, custom arch supports, or special footwear may be recommended. When there is a concern for ulceration and infection, your podiatric surgeon may recommend other treatments first, including particular types of casts and skincare and possibly even surgery. 

What are the special shoe options?

Many people with diabetes need special footwear prescribed by a podiatrist. Prescription footwear includes:

  • Therapeutic footwear. Immediately following surgery or as part of an ulcer’s treatment, some type of shoe may be necessary before a regular shoe can be worn.
  • Custom footwear. Custom footwear is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4- to 1/2-inch of depth throughout the shoe, allowing the extra volume to accommodate any needed inserts or orthoses, as well as deformities commonly associated with a diabetic foot. In-depth footwear also tends to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.
  • External shoe modifications. This involves modifying the outside of the shoe somehow, such as modifying the shape of the sole or adding shock-absorbing or stabilizing materials.
  • An orthosis or Custom Insoles. An orthosis is a removable insole that provides pressure relief and shock absorption. Both off-the-shelf and custom-made orthoses are commonly prescribed for patients with diabetes, including a special total contact orthosis, which is made from a model of your foot and offers a high level of comfort and pressure relief.
  • Custom-made footwear. A foot with deformities or amputations, a custom-made shoe can be constructed from a cast or model of the patient’s foot. With extensive modifications in the footwear, even the most severe deformities can usually be accommodated.

How long does special footwear typically last?

Like the regular footwear that you have worn in the past, except that occasionally the upper portion of the shoe may be made from a type of leather that stretches better such as deer hide. This softer leather can be stretched or will stretch as you continue to wear it, and it adjusts itself to the shape of your foot. Unfortunately, this comes at a cost since this type of leather is less durable. Independent of the type of leather used, if the shoe is beginning to break down, it should again be evaluated by the orthotist.

Similarly, the inserts also last a certain period based on your usage. Typically, if you see a concavity in your insoles, then it’s time to change them.   

When should I wear this footwear?

In general, this footwear is designed to be worn daily whenever you are on your feet. That being said, if your foot does not have significant deformity or loss of sensation, brief periods of time in a different type of shoe may not be so risky that it cannot be considered.

Are special footwear heavier than normal footwear?

There are many styles of special footwear. They may look different than regular footwear and sneakers, but usually aren’t heavier.

Something doesn’t feel right about my special footwear. What should I do?

Usually, it takes about a week or two, to get used to the new footwear or inserts. If it is mild discomfort, you should give some time for the body to adjust. If you have severe pain, skin discoloration, or blisters, please stop wearing the footwear and immediately call your orthotist.

By Dr. Sanjay Sharma 

Sourced and Modified from the original article by James Jastifer, MD

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