Nervous system disease

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
• Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
• Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

A common side effect of diabetes is “peripheral neuropathy,” which causes loss of sensation in the extremities. Ill-fitting shoes which rub or pinch the feet excessively can lead to ulceration and foot injury, simply because the diabetic does not feel the injury until it is too late.

Properly fitted diabetic shoes are very important in preventing such injuries. Companies specializing in pedorthics — the design of footwear and specialty insoles to help alleviate and/or prevent foot pain and injury — manufacture special shoes and insoles for diabetics.

Diabetic shoes are often wider and deeper than regular shoes, to make room for special diabetic insoles. Pedorthic insoles for diabetics are generally custom made for the patient’s feet, to ensure proper fit and minimize rubbing and uneven weight distribution, preventing injury. It is also important for a diabetic to have shoes with good air circulation, meaning a lot of diabetic footwear features fabric or sandal-style uppers.

It is very important for a diabetic to have their shoes custom fitted by a trained professional, since they may not be able to feel an improper fit, due to peripheral neuropathy. By ensuring proper fit and good air circulation, properly designed diabetic shoes and insoles prevent pressure ulcers, encourage good blood circulation, and allow the skin to breathe.

Some things to look for in good shoe designs for diabetics are:

• Diabetic Shoes need to have a breathable construction – sandals and fabric shoes are good for this.
• Deep and wide designs that allow room for custom pedorthic insoles.
• Designs with no interior seams (or covered seams) to prevent rubbing injuries.
• Diabetic Shoes need a roomy “toe box” to prevent pinching or squeezing of the toes.
• Elastic or easily adjustable fit, to prevent the diabetic shoe from sliding around on the feet.

Shoes and custom insoles which are specially designed to meet the needs of diabetics’ feet will often be partially or fully covered by Medicare or private insurance, offsetting the cost of the customization.