Many patients with diabetes can wear off-the-shelf shoes with no modifications. However, people who have foot deformities such as bunions, hammertoes, or Charcot joint (a form of joint breakdown) may need special inserts or specially made therapeutic shoes. Click here for a glossary of foot conditions.
What not to buy
Although there are a wide variety of shoes that are suitable for people with diabetes, there are also a few styles that should be avoided. High-heeled shoes fall into this category. High heels put increased pressure on the ball of the foot and place the back of the foot in an unstable position. They also increase shear, or the movement of foot tissues in opposing directions. Shear is a primary cause of calluses, blisters, and ulcers. A suitable heel will be less than one inch in height.
Slip-on loafers are another style that is best left in the store. Because there is very little of the shoe covering the top of the foot, these shoes provide inadequate support. They are also typically made of unpadded, rigid leather, which can be a source of friction.
Sandals that have straps between the toes are unsuitable as well, since the straps can cause irritation.
Ideally, the size for the arch measurement and the size for the heel-to-toe measurement should match. If they don’t, the size is usually based on the longer of these two measurements. But these numbers don’t tell the whole story, because even shoes with the same numerical size can vary in shape, height of the toe box, and overall depth. A person with a very thick foot or with joint changes in the foot may require an “extra-depth” shoe to accommodate the bulk of the foot or special shoe inserts.
Testing the shoe
Once your feet have been measured and you have chosen a shoe style, the real test is how they feel on your feet. Make sure you are wearing the type of sock or stocking you normally wear, and don’t forget to also bring any orthotics or inserts you will be wearing in the shoe.
Put on both shoes and attach the laces, buckles, or straps, then stand up. There should be some room, preferably 1/2 inch to 5/8 inch, between the tip of your longest toe and the front of the shoe. Walk around, and make sure that your arch is fully supported and that the break or bend of the shoe is located at the ball of your foot. Check how the width accommodates the ball of your foot — if the upper portion of the shoe is bulging out over the midsole, the shoe is too narrow and you should ask for a larger width. As you walk, note whether your heel moves around in the shoe. Try rising up onto your toes (holding onto something for support) and notice whether the heel slips off the back of your foot. A properly fitted shoe should slip slightly in the heel, particularly when new, but it should not move excessively or slide off the back of the foot. Make sure the sides of the shoe aren’t hitting your anklebones when you stand still or walk. Roll your feet to the insides as if you were trying to flatten your arches, then to the outsides, as if to roll over onto your ankles.
The shoe should feel like it is trying to restrict these motions, but it should not feel like it is placing excessive pressure against any one spot on the foot. Walk around the room for as long as you need to make sure the shoe is comfortable and supportive. Shoes should not need to be broken in, stretched, or otherwise modified. If this is suggested, do not purchase the shoes, because they are the wrong ones for your feet.
Although measurements of the feet offer a good starting point to find proper fitting shoes, each manufacturer builds their shoes on a different last and different styles by the same brand can also be built on different lasts resulting in different fits. The best way to accurately determine if a shoe fits properly is by trying them on. Be sure to wear the type of socks or stockings that would normally be worn and always try on both shoes together. Also make sure to stand up and walk around to ensure the shoes are comfortable and supportive.
Shoe Sizing Guide
What you’ll need:
two pieces of paper, each one larger than your feet
a ruler or measuring tape
Sit with one foot firmly on the floor, and your leg bent slightly forward so that your shin is slightly in front of your ankle.
Trace the outline of your foot. Please ensure that you trace your foot closely, but do not hold the pen at an angle.
Use your pencil to draw straight lines touching the outermost points at the top, bottom, and both sides of each tracing you’ve done. It’s important to do this for both feet, because everyone will have some variance between their right and left foot.
Use your ruler or measuring tape to measure both the length and width of your foot to the nearest 1/16th of an inch
Trace your other foot and repeat the process.
Note the longest and widest measurement from both feet as you want to order based on the largest measurements
After you have determined the length and width of your feet, subtract 3/16 of an inch from each measurement. This is to accommodate for the slight space between your foot and the line made by the pencil