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Fashion items for some, equipment for sport for others, a necessity for work – but for people with diabetes footwear is a must for health.

Why are shoes so important for people with diabetes?

Shoes should be worn to protect the feet. Let the sole of the shoe protect the sole of the foot.

Once the skin is broken or cut or pierced, there is no barrier to prevent the invasion of bacteria, which causes infection. The skin is the best defence against bacteria – the germs just can’t get in if the skin is sealing the body from the environment.

The skin acts like a door – locking the outside out.

But once the skin is broken, infection may result. If the door is left open, then the outside can come right in.

Diabetes makes the body’s defence mechanisms slower to react to the invasion of bacteria.

This results in sores taking a longer time to heal. The person with diabetes is more likely to have high blood sugar levels when an infection is present in the body.

When blood sugars levels are high, the body’s reaction to infection is slower. Unfortunately, when feet get infected they can make the body very sick and often requires the person to be put into hospital.

Footwear then helps to keep foot infections away and keeps people out of hospital.

Which shoes are best?

No one shoe will be suitable for every foot. The best shoe is one that fits well. A shoe that fits well will be comfortable to wear, does not require to be “broken in”, and does not rub on any part of the foot.

Socks are good to wear, as it provides a soft barrier between the foot and the shoe.

Some footwear, such as thongs and scuffs – offer very little protection for the foot. The sole of the thong will protect the sole of the foot, so it is better to wear thongs than bare feet.

However, the foot tends to slip and slide around on the thong as there is nothing to keep the foot in place when walking. As a result the foot is more likely to develop crooked toes and flatter feet. The skin is exposed in a thong and dry skin is more likely. Some feet are more likely to produce callous on the ball of the foot because of the sliding forces on the sole of the foot.

Reef sandals and other sandals with ankle straps or T-bars offer protection to the sole of the foot and the straps secure the foot to the shoe. There is less sliding of the foot, reducing the need to grip the toes, less likelihood of developing callous on the ball of the foot, the skin is still exposed so dry skin is probable. The straps if adjustable are not likely to cause rubbing on the toes or the rest of the foot.

As the shoe is open gravel and sand might get trapped between the foot and the sole of the shoe. This can potentially cause damage and trauma to the foot. As the toes are open, these are not protected from injury either.

Closed shoes offer many advantages for the foot, however it is essential to consider the disadvantages as well.

Closed shoes cover the sole, sides and top of the foot. This provides protection to the skin, prevents sand and gravel from entering the shoe, protects the skin from the drying forces of the environment, and secures the foot to the shoe. Good in theory.

However, closed shoes have the potential to cause problems to the foot. The closed shoe must fit the foot well, otherwise it is more likely to rub and potentially injure the skin. All closed shoes must be adequately wide across the ball of the foot, adequately long for the longest toe, and adequately deep to accommodate overlapping and crooked toes.

To check the fitting of the shoe, remove the insole from the shoe, if possible, place the insole on the floor, then place the bare foot on top of the insole. Does the outline of the foot fall within the boundary of the insole? Is there enough width and length? If the foot overhangs the insole it will press against the upper of the shoe. If there are seams in the upper in the area where the foot overhangs the insole, then it is definitely not appropriate.

If the insole cannot be removed from the shoe, get a large piece of paper, place it on the floor in front of the chair where the shoe fitting is to take place. Draw an outline of the sole of the shoe onto the paper – do both feet – left and right. Then place the foot on top of the shoe outline – take care to position the foot as if inside the shoe. Is there enough width and length?

Does the foot fall near or outside the outline of the shoe? If so, it will probably not be suitable. Is there sufficient room for the tops of the toes? Are there seams in the upper where the toes are crooked? If so, the shoe will not be suitable.

Closed shoes will collect sand and other things inside the shoe. Remember to shake out the contents of a closed shoe before putting it on. Remember to check for torn linings and other rough surfaces inside the shoe before putting them on. Put your hand inside the shoe to check it out. If it feels rough, it will cause irritation to your skin.

New shoes. Always wear new shoes around the house for a short time only, perhaps one hour, remove the shoe and check your skin for any irritation. If any red spots or pressure occurs on your skin from the new shoe – don’t wear them again until you ask for advice from a podiatrist or an Indigenous health worker. They might be able to adapt your shoe or recommend how it can be adjust the shoe to make it fit better. When in doubt – don’t wear the shoe!

Special diabetic considerations. Have your feet tested each year. The diabetic foot assessment of risk test [DART] will indicate if you have good sensation in your feet. If you test as a low risk with the monofilament test, this means that if the shoe rubs it will cause you some discomfort and you will want to get the shoes off as quickly as possible.

But if you test as a high risk with the monofilament test, there is a good chance that if the shoe does not fit well, you will not feel any discomfort or pain from the shoe. This is very dangerous as you could damage your feet wearing the shoes and not know it is happening.

High risk feet, must not wear ill-fitting shoes, as this can lead to ulceration, infection and amputation.

Some people with diabetes need to have shoes specially made for them. To receive this service, the health professionals looking after you, would need to work closely with the Health Department to organise this for you. It is a lengthy and sometimes difficult process, but very beneficial in the long term.

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