In this video, Dr. Pelto will go over tips for you if you have diabetes and need diabetic shoes or if you are a person fitting others with diabetic shoes. We will go over many of the common problems that can happen when fitting shoes for diabetics.
Transcript of Video
Hello and welcome to healthy living I'm Dr. Don Pelto and today I want to go over diabetic shoe fitting tips so this is going to be a presentation for you if you have diabetes or if you have a loved one or a caregiver that you're taking care of someone with diabetes or if you fit shoes even as a pedorthist a pedorthist is a profession where they fit shoes or orthotics or different type of devices for people with diabetes okay so let's let's get right into it we're gonna look at some common tips about finding the right shoes if you have diabetes so some of the most important tips are to shop for shoes in the afternoon well why you may ask do I have to buy shoes in the afternoon because in the afternoon is when your feet and to be more swollen so it's good to shop for shoes in the afternoon after your feet are more swollen if you go in the morning they might not have as much swelling to them and you might buy it the wrong size also wear the same types of socks to the store that you intend to wear with the shoes for example if you wear it like a nylon sock but you're gonna wear a normal thickness sock or a diabetic sock afterwards that shoe may be a little bit tight measuring both feet most people have one foot that's larger than the other so when you're measuring your feet as a diabetic you should first of all measure your feet right you shouldn't just buy a pair off the counter without having it measured you should measure your feet to make sure you're in the right type of a shoe and a lot of these tips are are for people that have diabetes in in it's for people that aren't only getting the diabetic shoes so there are certain shoes that are made for diabetics which we're going to talk about but these are just overall general tips that if you have diabetes you should be aware of them walk around in the shoes I think that's important don't just try on a pair say they look good and put them on and leave with them you should walk around if possible walk a little bit longer to see how they feel make sure that none of the seams bother you make sure they're not they're not injuring your foot or squishing on your foot and I tend to recommend getting it getting them when you bring them home wear them in the house for the first couple of days so you can keep them clean and if you do find that there's a problem within a couple of days you can bring them back to the store now if I did run this presentation by a couple of vidura thaiss and they asked me to add some of these topics in here and this is the one that bass to add shoe should have some room in the front as the toes splay when you're walking and what I mean by that is when you're when you're walking your toes tend to splay out and you should have a little bit of room in the front they shouldn't be too tight if you have diabetes you need there and for a lot of people you're gonna feel like your shoe that your proper size for you is actually a little bit big you may think well hey this is too big for me but usually it's not it should feel a little bit big and there is another reason why it could feel big and that could be neuropathy neuropathy is a lack of sensation and a lot of people with diabetes have and so you may not be able to feel the tips of your toes in your shoe that maybe feels right would actually be too small also don't trust your comfort level rather than the shoe size once again that because of the neuropathy that could cause that problem and pay attention to the width and where the widest part of your foot is you can see here this is a patient that has a hammertoe which is that toe that curves up like this also a bunion which is the inside and the tailor's bunion which is on the outside so the more of these other things that you have like the bunion and the tailor's bunion the wider your shoe needs to be so either your shoe needs to be wide or it has to have some type of stretch material on the side to allow for that bunion in that tailor's bunion there's a little tip here I recommend to get the right shoe size it's actually to take a tracing of your foot or to step on the shoe liner so one option is when you're at home step and then outline your foot and then when you do that outline of your foot and you put that on the actual liner you can see the picture on the right is that liner so you can either put your foot on the liner to see if any part of your foot is hanging over the side but if your big toe is hanging over the side or your bunions hanging over the side it's probably too narrow for you and you should get something that's a little bit wider and and just be told most shoes tend to be quite narrow and as a diabetic you need to find an appropriate truth and don't worry if it it's the right size you should wear it don't worry it's not all of what looks that's the problem with that or the shoes also make sure you get a ranek device and maybe this can be used to measure the width or the length of the shoe this can help as well also feel the inside or any tags or any seams and examine the soles or any cushioning or traction on diabetic shoes are notorious for not having any crack I don't know if they make it in Florida but they usually don't make them in New England and if to make sure you have traction on them otherwise you could be at a fall risk also be aware of that any seams inside the seam if for example if you have a big bunion on the side of your foot and the seam is right there it could push on and create friction it could push on your toes if there's a seam on the top of it would that's where it's better to look for a kind of a stretchy fabric that works better than something with seen what if you have a foot ulcer okay a foot ulcer is a foot wound and you have diabetes you can be fit for shoes but you shouldn't be wearing diabetic shoes okay I always recommend if someone has an ulcer you should be in either a surgical shoe or a walking boot or something else until that wound or that ulcer heals okay you should you shouldn't wear a diabetic Trude I better perfuse they're gonna squish your toes together too much and wearing some type of a surgical shoe or a walking boot that's gonna give you the width that you need it's gonna slow you down frankly that's that's important thing about an ulcer so let's look a little bit about the composition of a diabetic shoe here are some examples on the right these six shoes there you can see those are all diabetic shoes the main aspect of a diabetic shoe is that they have more depth to them so they are deeper inside and many times in on the sole region it's it's indented to give it more depth and then you have a spacer then you have a little that little thing that looks kind of like the same skin color kind of almost like a peach color that is the diabetic insole and that has the same density as your skin and that's where it's important to have your custom insoles your custom orthotics that come with it each diabetic pair of shoes comes with three sets of insoles or three sets of inserts and there's a couple of different types of inserts there are some that are heat molded and there's another type that are custom molded the heat mold that are the ones that are put in a almost like in a convection oven for a few seconds and then you step on it and it kind of forms to the lumps and bumps in your foot the other ones that are custom molded are ones that are actually modified on the bottom by adding different pads and things like that they can be fitting your foot appropriately and it can be it can be a challenge to find a diabetic shoe it can be a challenge to find someone that specializes in giving you diabetic shoes we'll look at some of the options here later on where can I get the shoes so let's talk about the process so first of all you have the primary care doctor or your endocrinologist you can get the shoes from them meaning you can get the shoe prescription from them and they are the ones that are going to fill out the paperwork there is paperwork that needs to be filled out and you have to verify that you either have or pulses a foot for matiee lack of sensation with a callus you have to have some type of a problem not just because you have diabetes and you get diabetic shoes not everyone with diabetes can get them there you have to have certain risk factor and then who actually sells them or does them many times a podiatrist may do it so uh podiatrist is a foot doctor and that specializes in feet and they may sell the shoes in their office or use a through your insurance of course pedorthist Fedora this is someone that has extra training and shoes and they can fit you or a diabetic true and orthotist is a person that makes orthotics there's different types of orthotics they can make orthotics or different types of orthotics or braces for your body there are some specialty shoe stores that sell diabetic shoes there are some people that are called DME providers so what a DME provider is someone that provides durable medical equipment and that is what a diabetic shoes considered a diabetic the durable medical equipment some pharmacies sell diabetic shoes and once again I think you should be careful if a person doesn't have any training and they're trying to give you a shoe it may not be any problem if you have a normal foot but if you have kind of a complex but you should probably see someone with a little bit more training online and they probably sell them you may not be able to buy them get them through your insurance but you could buy them but once again take caution because you'll get them you'll get the inserts but they're not going to be custom molded or heat moldable let's talk a little bit about the shoe with in depth this is something that's very important if you see the picture on the right-hand side you can see the the the the foot that's very squished inside the shoe that's what you don't want you need a wider toe box especially if you have a bunion or a bunion a door different types of bumps and the other thing that you need is something that's extra depth so for the other picture underneath there on the right you can see the hammer toes that are kind of curved down you need a deeper a deeper shoe or something that has some type of fabric that can allow some stretching for those hammer toes that's real important if you have diabetes and that's what if you look at the shoe composition here a soft leather added with foam that's gonna be for the in an extra depth that's circled there underneath those are gonna be important things another thing that's real important with diabetic shoes is you want to make sure that your shoe is easy to put on and there are a couple of techniques one is having Velcro that can have a strap or a tongue that can be lifted up all the way to allow you to put on that shoe a lot easier so the ease of use of putting on a shoe is real important if you have diabetes it shouldn't be it shouldn't be hard to put on also having a forgiving material and this is what I really recommend for most of my diabetic that have kind of some foot issues like hammer toes or bunions I recommend a softer material or some type of a stretch material there are different types of stretch shoes that and allow the bunions and things to push out and no one can really see it now if you can't find a spread shoe you can bring it to a cobbler and have it kind of modified let's talk a little bit about these the special foot beds you may be wondering well why do I get shoes every single year well the shoe doesn't wear out every year but these liners they're made to wear out there are custom ones and there are non custom ones and we went over that a little bit the picture on the right is a non custom insole and that would be heated up and it would be warm to your foot how do you evaluate the diabetic shoe insert well basically you squish it with your fingers and if there's no more cushioning it's probably worn out and they're made to wear out every four months that's why you get three pairs I think it's important to write the date on the bottom so you know when to switch it and they should be replaced even though they're worn out and I have a lot of patients they say well I have you know three or four pairs of diabetic shoes and that's why I don't want any new ones well the the shoe is made only the last as long as the insert so unless you can get more inserts the the inserts aren't doing their job in reducing the friction and some people also might need a custom orthotic if they have a different foot conditions that would need it a couple of other tips about shoe Closer it's important to get a good shoe closure if you if you don't want to do a Velcro velcro tends to work the best for closing shoes and allowing for any swelling in your feet another thing that you can do is that picture on the right there are actually laces that are elastic so elastic laces that something that might be a good idea for you if you if you need a shoe it's easier to put the shoe on but once again it will also allow you to accommodate if you if you have some swelling at the end of the day other types of adjustments that you might need to do with your scissors here that picture on the upper left you can go to a cobbler you can see is that little kind of that ball-and-socket there where it pushes in and stretches out the shoe if you have a bunion and then also if you have a limb length discrepancy the picture on the bottom on the left it's an example of an addition in the bottom if you have a height difference in the shoe sometimes you can do an insert in the shoe but if the height difference is too big you need to bring it to a cobbler and they can make that addition on the outside of Choo once again swelling some other shoe fitting problems these are some specific things for you if you have diabetes and if you're looking for shoes so how do you deal with swelling as we talked about getting a shoe that's extra depth and then also some stretch laces or even the velcro those can be helped swelling if you have a blister or a callus you see on the side of that little toe you need to make sure that shoe is wide enough cuz there's gonna be some rubbing and also just care for you aren't being too active or if you don't have a hammer though there an ethical hammer toe rub on the side of the shoe make sure there's no seeum in that area and make sure that your shoe is wide enough give a blister an ulcer and once again if you have an ulcer or an actual wound you don't want to wear those shoes until you get that healed blistering gonna be blistering in the back of the heel or other other types of areas and I kind of like to simply explain that a blister is usually the same as an ulcer if you have diabetes so it's the same thing a blister and an ulcer are the same thing they usually happen on areas of high pressure or callosum and usually from improper fit or too much walk so if they're in you know you're not fitting well you're gonna be slipping in the back or if you're just doing way too much that can be a problem how about blood underneath the nail so blood underneath the nail if if that nail is still attached you should leave it if it's detached you should see someone to have a nail removed but usually it's caused from a shoe that's either too tight or too small or you're doing too much walk so just be aware if this happens if you get a brand new shoe and you find that you get blood underneath the nail you really have to determine if that's a proper shoe for you once again a blister or an ulcer caused by too much walking or lack of movement of the joint a lot of times if you have arthritis in the joint one of the joints before where the blister is it can cause increased movement at the joint after where the where the movement is also how do you find shoes if you have a big bunion or overlapping hammer this is a difficult foot you can see that big bunion the hammer toe it's difficult you're gonna you're gonna want a shoe that's very very deep and one that has the stretch fabric that's gonna be best you're not gonna want a very narrow shoe otherwise it's gonna be too uncomfortable for you if you have a foot that looks like this and if you have a hammertoe this is an example of an ulcer you can see the top of it you can see that how that toe is kind of curved up and that rubbed on the shoe that that ulcer is a problem to fix it with a shoe you need one that has extra depth in the stretch fabric or you may even need to surgically fix either that a Myrtle or that bunion that would be a way of fix it as well there are some other solutions if you have calluses see that big callus on the upper right hand corner you see from the toes are rubbing it has that big callus between there a callus should be shaved down but there are different types of toe caps there are spacers different things that can help add that area make your foot feel better but normally with a foot like that you're gonna be seeing a professional to do the analysis and the nails and you have to make sure though your shoes when you buy them there have extra width so they're not gonna be rubbing this hammer toes on the bottom or on the tips of the hammer toes there are gonna be calluses and these calluses you can use a crest pad which is that pad on the bottom right hand corner there that's a crest pen that it's like a crest like a Halfmoon that goes underneath the toes you can also modify and add that into your orthotic if you do a custom insole that can be added there to put less pressure and then once again you can fix those surgically as well and then what about socks diabetic socks are recommended because they have increased pushin they reduce your moisture they're non-binding and they don't have any seams that's what makes a diabetic saw and I always recommend just finding a place where you can go and get them for a dollar of air and once they wear out you should switch them don't wear them too long and just be careful you don't want to sock that as seams or that's too tight if you're finding that your sock is making lines around your legs because if you're swelling it's probably too tight so you may want to consider a diabetic sock and also a compression sock if you have a lot of swelling a compression sock may be indicated but really be careful on your toes because of those squished together too much to create source from that squishing of the compression socks what if you don't have diabetes what shoe do I recommend I recommend a new balance this is a 900 series New Balance this is a very stable shoe you don't have diabetes it works very well my patients and then some other questions what about weak ankles if you have diabetes or just weekend I recommend a good boot here that's gonna help them at how do you evaluate your shoe this is a good tip you want to bend and twist your shoe and it should Bend in the middle of the shoe and it should twist in the middle if it if it I'm sorry at the front of the foot you can see at the front of the big toe joint that's where as many and twisting if it bends right in the middle right in the middle it's it's not giving you enough if I have big feet and I need to wear men's shoes if you're a woman just wear them it doesn't matter if the men are a woman Chu no one's gonna know you need to find something that's appropriate so those are the the diabetic shoe fitting tips here if you want to learn more you can certainly look on our website at central mass podiatry but here are just some great tips if you have diabetes and you're looking for the proper shoe thank you
