The management of diabetes requires specialized care for the feet to prevent severe complications. Inappropriate footwear is a significant risk factor that can lead to unnoticed injuries, which may progress into serious foot ulcers and infections. Because of the physiological changes caused by diabetes, ordinary shoes often fail to provide the necessary protection and support. Selecting therapeutic footwear is a proactive measure to safeguard foot health against permanent damage.
Understanding Diabetic Foot Vulnerabilities
Diabetes compromises the feet through two primary conditions that establish the need for specialized protective shoes. The first is peripheral neuropathy, nerve damage that causes a loss of protective sensation. This means a person may not feel friction from a poorly fitting shoe or a small cut, allowing minor injuries to escalate undetected into serious wounds.
The second condition is peripheral arterial disease, a circulation disorder where blood flow to the lower extremities is reduced. Impaired circulation slows the delivery of oxygen and nutrients needed for healing. Consequently, any wound that develops will heal slowly and is prone to infection, which can quickly lead to tissue death and potentially require amputation. Specialized footwear mitigates the risks created by both the inability to sense injury and the body’s reduced capacity to repair itself.
Essential Structural Features of Protective Footwear
Therapeutic shoes are engineered with features designed to reduce pressure, prevent skin breakdown, and accommodate foot deformities.
Extra Depth and Wide Toe Box
A foundational requirement is extra depth and a wide toe box. This design prevents the compression of the toes and provides sufficient volume for the foot. This space allows toes to move freely and ensures that custom orthotic inserts can be accommodated without the foot being squeezed, which is a common cause of pressure points.
Seamless Interior and Breathable Uppers
The interior of the shoe must be seamless, utilizing soft, padded linings to eliminate friction and rubbing against the skin. Seams and stitching present in conventional shoes can create abrasive spots that cause blisters or sores on a desensitized foot. The upper materials are made of breathable components, such as soft leather or advanced synthetics, to promote air circulation and maintain a dry, healthy environment.
Stability and Rocker Soles
The outer structure includes a firm heel counter, which provides stability to the rear of the foot and helps maintain proper alignment during walking. The sole is thick, rigid, and designed with a rocker bottom shape that reduces the pressure exerted on the ball of the foot and the metatarsophalangeal joints during the gait cycle. This design limits the movement of joints vulnerable to ulceration, effectively transferring body weight to less sensitive areas. The closure mechanism should be adjustable, using laces or Velcro straps, to secure the shoe firmly without constricting circulation.
Proper Fitting and Sizing Procedures
The fitting process for diabetic footwear is a precise procedure that differs from purchasing standard shoes and requires careful attention.
Measuring and Timing
It is advisable to have feet measured later in the day, as feet naturally swell and will be at their largest size in the afternoon or evening. This practice ensures the shoe will fit comfortably when the foot is at its maximum volume, preventing tightness. Both feet must be measured for length and width every time new shoes are purchased, because foot size and shape can change over time. Since one foot is often slightly larger than the other, the shoe size should always be based on the dimensions of the larger foot to prevent compression.
Checking the Fit
Shoes should be tried on while wearing the specific type of thick, seamless socks or orthotics that will be used daily. Proper fit should confirm that there is adequate space, about a thumb’s width, between the longest toe and the tip of the shoe. The heel should be snug enough to prevent slippage while walking, but the fit should never feel tight or cause tingling, which restricts blood flow. New shoes should be broken in gradually, worn for only an hour or two on the first day, and the feet should be checked immediately after removal for any signs of redness, blisters, or pressure marks.
Customization and Medical Coverage
For individuals with advanced foot deformities, such as Charcot foot, or those with existing ulcers, standard therapeutic shoes may not suffice. Custom-molded shoes may be necessary, constructed over a positive model, or cast, of the patient’s foot for a personalized fit. These custom shoes accommodate complex shapes that cannot be managed by off-the-shelf options and include removable inserts for adjustment.
Even with extra-depth shoes, prescription-grade, multi-density inserts are required to distribute pressure evenly and correct gait abnormalities. These customized orthotics are a separate component of care, often replaced more frequently than the shoes themselves, to maintain optimal pressure relief.
In the United States, therapeutic shoes and inserts for qualifying patients are often covered under Medicare Part B, which recognizes their role as a preventive medical necessity. Coverage is limited to one pair of extra-depth shoes and three pairs of inserts, or one pair of custom-molded shoes and two pairs of inserts, per calendar year. To qualify for this benefit, a physician managing the diabetes must certify the need for the footwear due to specific foot conditions, such as a history of ulceration or peripheral neuropathy. After the yearly deductible is met, Medicare generally covers 80% of the cost, leaving the patient responsible for the remaining 20% coinsurance.