You know how important good foot care is to people with diabetes. You probably also know that properly fitting shoes are one of the basic ways to protect your feet. What you may not know is how to find shoes that fit properly. This article will help you put your best foot forward in selecting footwear.
Finding well-fitting shoes seems simple enough, but the fact is many shoes are unfittable. They may be the wrong shape for your feet. They may not be well constructed. They may not be available in the correct size.
Often, shoes are sold by inadequately trained sales staff. In many shoe stores, the sales staff is there primarily to ferry boxes of shoes back and forth and ring up sales. Proper size selection and fit is left up to the customer.
Shoe store staff usually fail to mention that shoe sizes vary even among shoes made by the same manufacturer. Size may vary with style of shoe, and some shoe styles may never fit your feet comfortably.
The Last Is First
Shoes are made over forms called lasts. Lasts are supposed to be shaped like a person’s foot, but shoe stylists often pervert anatomy for the sake of style. Because of the way shoes are constructed, size seven shoes – made over different lasts – may actually have different dimensions. In other words, all size sevens are not created equal.
Another element of shoe design that affects fit is the vamp. The vamp is the part of the shoe that covers the instep and, in some styles, the toes. In this area, the shoe manufacturer has complete leeway. Shoes that measure the same length and width may fit differently depending on the vamp style.
A trained shoe fitter will measure both feet in a standing position. He or she will measure foot length from heel to toe and then measure the foot from heel to ball. The ball is the widest part of the foot.
When you try on the shoes, the fitter will check the fit by noting the position of the ball of each foot in relation to the ball of the shoe. The ball of the foot should rest within the ball of the shoe. Then, as you walk a few steps, the fitter will observe the shoe’s fit. Signs of a poor fit include the forefoot rolling over the sole, too much space between the heel and the back of the shoe, the shoe fitting too snugly in the ball area, and the ball of the foot being too far forward to the break or “ball” of the shoe. The fitter will make certain that the shoes provide plenty of room for your toes and will check the width by feel. A qualified fitter will be able to detect tightness that you may not be able to sense.
Protect your feet by purchasing well-fitting, well-constructed shoes. If stores near you do not employ trained shoe fitters, educate yourself about good shoe choices. Check with your podiatrist or physician for suggestions. They may even be able to recommend a shoe store.
Both pedorthists and podiatrists can help with shoe fit. Pedorthists are trained in the design, manufacture, and modification of shoes and related prescription foot appliances that are used to treat painful or disabling foot conditions. Podiatrists are physicians of the foot and are also expert in shoe fitting. Pedorthists or podiatrists can help the fit of shoes by adding pads, pressure-relieving devices, and they can make custom-molded shoes. In many areas, qualified shoe fitters are members of the Prescription Footwear Association. Certified pedorthists (C.Ped.) are credentialled by the Board for Certification in Pedorthics.
Bad News Shoes
Shoes with the following features may cause foot problems for both people with and without diabetes:
- High heels. These force the entire weight onto your forefoot, a frequent site of ulcers.
- Pointed or tapered toes. These push toes to the center.
- Receding toes. Although shoes whose toes taper down may look more stylish than those with a high toe box, this type of toe pushes down on the toes of your feet. In effect, it makes the shoes too short.
- Flimsy shanks. The shank is the narrow part of a shoe sole in front of the heel and beneath the instep. Shoes with flimsy shanks provide no stability.
- Sparse uppers. Shoes in this category include slip-ons and pumps. There is so little upper that these must usually be fitted too snuggly or they will fall off.
In shoe selection, be ruled by comfort and good fit rather than fashion. Most stylish shoes are available in only one width. This is particularly true of imports, which make up 80 percent of the shoes sold in this country. This creates problems for people with feet that are narrower or wider than average.
People with narrow feet are often fitted with shoes that are too short. The result may be corns, hammer toes (toes bent upward in the middle like a claw), and bunions. People with wider feet are sold shoes that are too long, so that the foot can get into the shoe. Result: The widest part of the foot may fall into the narrowest part of the shoe.
The Good Shoes
Talk to your health-care team about good shoe choices. The safest shoes are lace-up models with rounder toes, fairly high toe boxes, and softer uppers made from deerskin. These foot-shaped shoes assure that the big toe is not pushed over into a bunion shape, that the middle toes are not crowded into the hammer toe position, and the outside border of the foot is not compressed.
The outer sole material is also important. Outer soles made of resilient material such as composition crepe rubber are preferable to those made of hard, thin material.
How a shoe laces can also affect fit. For a safe fit, the higher the shoe is laced on the foot the better. A higher lacing means less chance of the shoe slipping at the heel.
Shoes can also be made to fit better with the help of pads and insoles. For example, soft pads applied to the back of the shoes’ tongues can help tighten up the fit in the heel area.
Specially made shoes include those with removable insoles. These can be removed to provide additional vertical depth. This extra space makes it possible to adapt the shoes to the individual wearer’s needs with devices such as special insoles, arch supports, and in-shoe braces. These shoes can also more easily accommodate swollen or unusually thick feet or feet that are bandaged.
Special insoles made of plasticized materials are sometimes prescribed for people with diabetes. These help protect the soles of the feet. Plasticized foam can be shaped over a cast of the foot or over the foot itself. These insoles provide total contact from heel to toe. Originally invented to protect insensitive feet of the victims of leprosy, these insoles have proven useful to people with arthritis as well as those with diabetes.
To extend the life of these insoles, it’s a good idea purchase two pairs and alternate them. The insoles are washable and are available in several densities. Two thicknesses of Plastazote in different densities can be combined to make a single insole, with the softer lying next to the foot, buttressed by the more dense. Other materials with similar properties to Plastazote are available.
Some shoes can be shaped, after heating, to accommodate large bunions, hammer toes, or bumps on the feet. These are sold as Thermolds.
For feet that cannot fit into stock prescription shoes, there are custom-molded shoes that are made over casts of the feet. These are expensive and not always perfect, but when nothing else will suffice, they can be extremely helpful.
Protect your feet by putting time and care into selecting well-fitting footwear. If you’re having trouble fitting your shoes, get help from your foot care team. Proper fitting shoes should be the first step in taking care of your feet.
- Select shoes that are shaped for the human foot, preferably ones that lace up, have rounded toes, and soft leather uppers.
- Wear shoes that are of adequate length, width, and depth. Shoes should not compress the toes or foot. The uppers should be of soft leather, preferably kidskin or deerskin. The outer sole material should be resilient rather than hard and thin.
- Check that the ball of the foot rests in the widest part of the shoe.
- Wear new shoes around the house on carpeting for about an hour and then check for any hot spots or any problem areas.
- Replace your shoes regularly. Have at least two pairs of well-fitting shoes to alternate so that shoes can dry between wearings.
- Have your feet measured every time you purchase a pair of shoes.
- People prone to diabetes-related foot problems should not wear a new pair of shoes for more than two hours without checking their feet for pressure areas. Five hours should be the maximum length of wear for one pair of shoes.