Diabetes Forecast March 2004

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FOR TYPE 1/TYPE 2

How To Shop For Shoes

If you have diabetes, footwear is more than a fashion statement. Here are some tips for buying the right pair of shoes.
by Neil M. Scheffler, DPM, FACFAS

What do shoes mean to you? Some people view them simply as functional coverings to protect their feet, no more than an updated version of the animal skins used by cave dwellers. Others purchase many pairs of shoes as fashion statements. Just think of the former First Lady of the Philippines, Imelda Marcos, and her controversial 3,000-pair collection. If you have diabetes, however, you must think of more than style when choosing shoes.

Diabetes can cause nerve and vascular damage in your feet that may, without care, lead to complications such as infection, foot ulcers, and amputation. Experts acknowledge that good footwear can help prevent these complications. That's why it's so important to know what to look for when you buy shoes.

Your first step should be a visit to your podiatrist (foot doctor). He or she will be able to tell you if you are at special risk for foot problems because of abnormal nerve function or circulation, or deformities such as bunions or hammertoes. Sometimes a prescription for special shoes, shoe inserts (orthotics), or even custom-made shoes is in order. If you qualify, Medicare pays for one pair of shoes per year and special inserts for those shoes. (See "Medicare Therapeutic Shoe Program," below.)

Next, choose the type of shoe you need. What will the shoes be used for? Will an athletic shoe suffice, or do you need dress shoes for work? Do you need a special shoe to accommodate orthotics? Here are a few tips to keep in mind while shopping:

• Try shoes on with the socks that you intend to wear with them. Bulky socks take up room and may cramp your toes, so if you use them regularly, be sure to wear them when you try on shoes.
• Shop in person. Do not buy shoes through the mail. They should be fitted by an experienced shoe fitter who can tell if the shoes are right for you.
• Try shoes on late in the day. Feet swell, and shoes that fit in the morning may not fit in the evening.
• Don't forget shoes for the beach or pool. Never go barefoot, not even in the water. Wear sandals at the beach and swimming shoes in the water.
• Feet change size, so have them measured each time you shop for shoes. Weight gain or loss will affect your shoe size; also, your feet may become longer and wider if the arch "drops."
• Make sure that both feet are measured. They may be different sizes. Fit the foot that is longest. Sometimes the longest toe is the second toe. Fit the shoe to this toe.
• The widest part of the shoe should coincide with the widest part of your foot.
• If your podiatrist has given you orthotics, take them with you and try shoes on with them in place.
• Make sure the toe box is deep enough. There should be enough room to wiggle your toes.

Additional Resources American Physical Therapy Association 1111 North Fairfax Street Alexandria, VA 22314-1488 1-800-999-APTA 1-800-999-2782 www.apta.org/Consumer Amputee Coalition of America 900 East Hill Avenue Suite 285 Knoxville, TN 37915-2568 1-888-AMP-KNOW 1-888-267-5669 www.amputee-coalition.org

• Walk around the store in the shoes. They should be comfortable right away. Despite what a salesperson might say, shoes should not need to be "broken in." Some athletic shoe stores even have a track or treadmill that you can use to try out new shoes before you make a purchase.
• Shoes with laces are preferable to slip-ons. Slip-on shoes are made narrow so that your feet won't slip out. Shoes with laces can be made wider—just loosen the laces.
• If you have nerve damage or decreased sensation, pay extra attention to what size the shoes are. Go by size, instead of how they feel. People with nerve damage or decreased sensation often buy shoes that are too tight. Also, for the first few days, you should evaluate your feet every couple of hours to make sure the new shoes are not causing blisters or irritation.
• Avoid materials such as plastic or synthetic leather that do not "breathe."
• Choose a cushioned shoe rather than one with a stiff, leather sole. A running shoe is preferable to a leather-soled oxford.
• If you have a deformity such as Charcot foot, bunion, or hammertoe, you may need special shoes. Make sure the shoe fitter knows this. Better yet, be prepared with a prescription from your podiatrist.
• Flat shoes are better than those with high heels. The higher the heel, the more your foot is placed in a toe-down position. This loads pressure on the forefoot and cramps the toes as the foot slides forward.
• Check inside the shoe for seams or rough spots that could rub.
• After you take the new shoes home, wear them around the house for an hour or two. Then examine your feet. If there are any red or irritated areas, return the shoes.
• Keep your shoes in good repair. Some innersoles need replacement every few months.

 

Once you have comfortable shoes that fit properly, wear them. Shoes protect your feet from debris, dirt, and the elements. Check your feet when you take your shoes off, at least once a day, and stop wearing shoes that cause any irritation or injury. Keep your feet healthy and well-shod and they will last a lifetime.

Neil M. Scheffler, DPM, FACFAS, is a podiatrist in private practice and president of the Baltimore Podiatry Group in Baltimore, Md. He is past President of Health Care & Education, Mid-Atlantic Region, American Diabetes Association.

Medicare Therapeutic Shoe Program In an effort to prevent foot ulcers in people with diabetes who are at risk, Medicare will help pay for therapeutic shoes. For those who qualify, Medicare will pay 80 percent of the allowed amount for one pair of shoes and up to three pairs of molded innersoles per year. (The allowed amount varies depending on the kind of footwear you need.) Most secondary insurers will help pay the other 20 percent. Who Qualifies? To qualify, you must be under a comprehensive diabetes treatment plan and have one or more of the following: history of partial or complete amputation of the foot history of previous foot ulceration history of pre-ulcerative callus peripheral neuropathy with evidence of callus formation foot deformity poor circulation What Paperwork Is Required? The physician treating you for your diabetes must certify that you have diabetes, that you have one or more of the foot problems just mentioned, that you are under a comprehensive diabetes treatment plan, and that you need the special shoes. Medicare has a form for this certification. You will also need a prescription for the shoes. Who Prescribes The Shoes? A prescription is required from a podiatrist or physician who knows how to fit shoes and inserts for people with diabetes. The prescription should indicate a particular type of footwear, such as shoes, inserts, or modifications. Who Supplies The Shoes? The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a pedorthist, orthotist, or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a defined rural area or area where there is a shortage of health professionals. The prescribing podiatrist may be the supplier. What Do You Get? Coverage is limited to one of the following per calendar year: One pair of off-the-shelf extra-depth shoes and three additional pairs of special inserts that your podiatrist will select for you. Extra-depth shoes have room to accommodate innersoles or orthotics. One pair of off-the-shelf extra-depth shoes including a modification, and two additional pairs of special inserts. One pair of custom-molded shoes and two additional pairs of special inserts. —Neil M. Scheffler, DPM, FACFAS