Diabetes threatens your feet in two major ways:
[1] It can cause neuropathy (nerve damage) that reduces your feet's sensitivity to pain. This starts off as funny, tingly feelings in your feet... signs of abnormal nerve function. Eventually you can lose all sensation in your feet and are not able to feel anything at all. You could break a toe or step on a piece of broken glass and never feel a thing.
[2] Diabetes can also cause poor circulation. This is because high glucose levels in your blood can narrow the small blood vessels in your feet, restricting blood flow. When the blood flow in your feet is reduced, any wounds you get heal more slowly.
In addition to these two major threats, foot deformities, such as bunions or hammertoes, can also create pressure points that result in ulcers developing. Because you are diabetic, your immune system is less effective, so these ulcers and other infections take much longer to heal.
If these foot ulcers and infections prove impossible to cure, your doctor will have no choice but to recommend amputation of the infected foot. However, at this stage, the pains in your feet will have become so unbearable that you'll probably welcome amputation, even though it means crutches or a wheel-chair for the remainder of your life.
Preventing damage
There are three things you can do to avoid damaging your feet beyond repair.
The first is to exercise stringent control over your blood glucose levels in order to prevent diabetic neuropathy or prevent it getting any worse than it is already.
The second is to check your feet carefully every day for blisters, sores, cuts, redness, warm areas, swelling, ingrown toenails, and so on. If you find anything abnormal, show it to a doctor or nurse and have it treated ASAP.
The third is to wear the right kind of shoes.
In addition, you should wear slippers around the house because going barefoot exposes your feet to injury. And if you go swimming, you should wear protective shoes in the water.
So what is the right kind of shoes?
Choosing shoes wisely
To choose the correct shoes you need to answer several questions:
How healthy are your feet? Do you still have normal sensation in your feet? How bad is any loss of sensation? Do you have any abnormalities or foot deformities? How painful are your feet when you walk?
According to experts, diabetics with good blood sugar control and healthy feet can wear ordinary shoes. Indeed, if this is you and you are a woman, you can even wear high heels around the office, ie for short periods when you are not doing much walking; but not when travelling to and from your work. However, if the sensation in your feet is impaired, you should avoid high heels because you won't feel the stress these kinds of shoes put on the forefoot and toes.
For diabetics with impaired sensation and circulation, or minor foot deformities, special diabetic shoes (or comfort shoes) are available. These shoes are made of soft leather. They have a deep toe box that is rounder and wider than usual.
My person preference is to use jogging shoes or runners. My favourite brand is Asics because they have a gel in the sole which seems to absorb all kinds of shocks from walking on concrete. I buy a size that is about two sizes larger than the size I wear in conventional shoes (ie, a size 12 instead of a 10) because this gives me plenty of room for my toes. I can walk comfortably with these runners.
The only real drawback with Asics or other brands of runners is the garish colours. Currently I'm wearing bright blue runners because that was the only colour available when I bought them. I'm looking forward (as are my diabetic colleagues) to the day when the makers of sports shoes start making their runners in discrete shades of brown, black or grey.
Bad shoes
There are several types of shoes that all diabetics should avoid.
Don't wear flip-flops. They expose the toes to injury. In addition, they are not very supportive, and the strap that goes between the toes can cause a blister or irritation.
The standard rigid leather-style shoes should also be avoided. They are usually not flexible enough for diabetics, so if you have a blister or irritation, the shoe cannot expand.
Prescription shoes
If your feet are very bad, if the circulation in your feet or the sensations you can feel deteriorate significantly, or you develop foot ulcers or deformities, a range of therapeutic shoes is available. Before buying these you should seek the advice of a qualified podiatrist.
Depth shoes are shoes with extra vertical room so that artificial foot supports, such as custom-moulded inserts, can be used. Most foot ulcers are related to pressure and depth shoes with mould inserts are designed to redistribute the pressures on the foot.
If your feet are so badly deformed that they cannot be accommodated by any other kind of shoe, you may need custom-moulded shoes. In these kinds of shoes, the entire shoe is moulded from a cast of your foot.
Shoe-buying check-list
Here are some pointers for buying new shoes:
[1] It can cause neuropathy (nerve damage) that reduces your feet's sensitivity to pain. This starts off as funny, tingly feelings in your feet... signs of abnormal nerve function. Eventually you can lose all sensation in your feet and are not able to feel anything at all. You could break a toe or step on a piece of broken glass and never feel a thing.
[2] Diabetes can also cause poor circulation. This is because high glucose levels in your blood can narrow the small blood vessels in your feet, restricting blood flow. When the blood flow in your feet is reduced, any wounds you get heal more slowly.
In addition to these two major threats, foot deformities, such as bunions or hammertoes, can also create pressure points that result in ulcers developing. Because you are diabetic, your immune system is less effective, so these ulcers and other infections take much longer to heal.
If these foot ulcers and infections prove impossible to cure, your doctor will have no choice but to recommend amputation of the infected foot. However, at this stage, the pains in your feet will have become so unbearable that you'll probably welcome amputation, even though it means crutches or a wheel-chair for the remainder of your life.
Preventing damage
There are three things you can do to avoid damaging your feet beyond repair.
The first is to exercise stringent control over your blood glucose levels in order to prevent diabetic neuropathy or prevent it getting any worse than it is already.
The second is to check your feet carefully every day for blisters, sores, cuts, redness, warm areas, swelling, ingrown toenails, and so on. If you find anything abnormal, show it to a doctor or nurse and have it treated ASAP.
The third is to wear the right kind of shoes.
In addition, you should wear slippers around the house because going barefoot exposes your feet to injury. And if you go swimming, you should wear protective shoes in the water.
So what is the right kind of shoes?
Choosing shoes wisely
To choose the correct shoes you need to answer several questions:
How healthy are your feet? Do you still have normal sensation in your feet? How bad is any loss of sensation? Do you have any abnormalities or foot deformities? How painful are your feet when you walk?
According to experts, diabetics with good blood sugar control and healthy feet can wear ordinary shoes. Indeed, if this is you and you are a woman, you can even wear high heels around the office, ie for short periods when you are not doing much walking; but not when travelling to and from your work. However, if the sensation in your feet is impaired, you should avoid high heels because you won't feel the stress these kinds of shoes put on the forefoot and toes.
For diabetics with impaired sensation and circulation, or minor foot deformities, special diabetic shoes (or comfort shoes) are available. These shoes are made of soft leather. They have a deep toe box that is rounder and wider than usual.
My person preference is to use jogging shoes or runners. My favourite brand is Asics because they have a gel in the sole which seems to absorb all kinds of shocks from walking on concrete. I buy a size that is about two sizes larger than the size I wear in conventional shoes (ie, a size 12 instead of a 10) because this gives me plenty of room for my toes. I can walk comfortably with these runners.
The only real drawback with Asics or other brands of runners is the garish colours. Currently I'm wearing bright blue runners because that was the only colour available when I bought them. I'm looking forward (as are my diabetic colleagues) to the day when the makers of sports shoes start making their runners in discrete shades of brown, black or grey.
Bad shoes
There are several types of shoes that all diabetics should avoid.
Don't wear flip-flops. They expose the toes to injury. In addition, they are not very supportive, and the strap that goes between the toes can cause a blister or irritation.
The standard rigid leather-style shoes should also be avoided. They are usually not flexible enough for diabetics, so if you have a blister or irritation, the shoe cannot expand.
Prescription shoes
If your feet are very bad, if the circulation in your feet or the sensations you can feel deteriorate significantly, or you develop foot ulcers or deformities, a range of therapeutic shoes is available. Before buying these you should seek the advice of a qualified podiatrist.
Depth shoes are shoes with extra vertical room so that artificial foot supports, such as custom-moulded inserts, can be used. Most foot ulcers are related to pressure and depth shoes with mould inserts are designed to redistribute the pressures on the foot.
If your feet are so badly deformed that they cannot be accommodated by any other kind of shoe, you may need custom-moulded shoes. In these kinds of shoes, the entire shoe is moulded from a cast of your foot.
Shoe-buying check-list
Here are some pointers for buying new shoes:
- Make sure the uppers are soft and stretchable.
- Laced shoes are better than slip-ons (loafers) because they fit better and offer more support.
- A cushioned sole absorbs shocks much better than a thin leather sole.
- A sole containing gel is best.
- Try on shoes later in the afternoon because your feet swell a bit during the day.
- Try on shoes while wearing the socks that you'll be using with them.
- Make sure there is plenty of room between your big toe and the tip of the shoe, at least half the width of your thumb.
Paul D Kennedy is a type 2 diabetic. He used his skills as
an international consultant and researcher to find a way to control his
diabetes using diet alone. He stopped taking medications to control his
blood glucose levels about five years ago.
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