December 27, 2012

Do You Have Happy or Unhappy Feet?

Most articles about shoes are written for women, by women, and I do not totally understand why. Is it because women own more pairs of shoes and require a pair for every dress they wear and others for when they hike, or get out in the country? Men often wear shoes that do not fit properly and then they wonder why they have sore feet and areas on their feet that are hard because of calluses that aren't taken care of until sores develop.

Why is that people with diabetes refuse to take care of their feet until forced to because of a possible amputation looming. Yes, I am being anything but understanding or sympathetic toward people who have diabetes and insist on abusing their feet. When they start complaining about feet that hurt, they know that I will not feel any sympathy and may be very difficult to get along with. Yes, I am aware of this being the wrong way to make friends and influence people. Even in the diabetes clinic, I see people wearing shoes that are wrong – spike heels, flip-flops, sandals with poor heal support and other improper shoes.

I have finally met two doctors that are very strong advocates for proper footwear. I could not believe it when I heard it, but one doctor will not treat patients for foot problems, men or women, wearing improper footwear. The type 2 patient, a man wearing flip-flops had cut his foot at home after dropping a glass container, which broke in many pieces. The doctor told him he would need to go the emergency room for treatment. The ER doctor did treat him, but said he would need to purchase a proper set of house slippers or shoes to continue being treated if he had problems healing.

Both doctors are very set on people with diabetes wearing proper footwear. The doctor that has his own practice does have a foot measuring device to show people the correct size and posters showing the incorrect footwear for both men and women. If you don't want to be embarrassed when he insists on measuring your foot and tells you your shoes are too small, you will want to avoid this doctor. His advice is correct though as many people insist on wearing shoes that are too small for them. A few people do wear shoes that are too large. This is an invitation for developing blisters and calluses.

This article from WebMD has some excellent pointers and even if the United Kingdom is the setting, the information is still valid. The information given shows that only 25 to 40 percent of people with diabetes wear shoes that are the correct size. Because the information given is great, I will quote it. “When people with diabetes start experiencing nerve damage or numbness, they often gravitate toward shoes that are too small because tight shoes make it easier for them to feel the snugness on their feet. They mistake that tightness for good support. Instead, they need to wear shoes with comfortable -- not tight – support.”

Once you know your correct size, here are nine guidelines for choosing shoes when you have diabetes:
1. Look for shoes that don't come to a point at the toe. Instead, choose shoes with a spacious "toe box" -- the forward tip of the shoe where the toes are. That way your toes won't be crushed together. When your toes have space, it lessens the chance of corns, calluses, and blisters that can turn into ulcers and eventually infections.
2. If the shoe's insole is removable, take it out and step on it. Your foot should fit comfortably on top of it with no overlap. If your foot is bigger than the insole, then your foot will be crammed inside the shoe when you wear it. Choose a different shoe.
3. Avoid high-heeled shoes because they put unnatural pressure on the ball of your foot. If you have neuropathy, you may not realize that you are sore there or even getting calluses. High heels also can cause balance issues and ligament damage.
4. Steer clear of sandals, flip flops, or other open-toe shoes. Straps can put pressure on parts of your foot, leading to sores and blisters. In addition, open shoes can leave you susceptible to injury like cuts. They also can allow gravel and small stones to get inside the shoe. These can rub against your feet, causing sores and blisters.
5. Consider laced shoes instead of slip-ons. They often provide better support and a better fit.
6. Try on shoes at the end of the day. That's when your feet are more likely to be a little swollen. If shoes are comfortable when your feet are swollen, they should feel fine the rest of the time, too.
7. Don't buy shoes if they are uncomfortable, planning to break them in as you wear them. Shoes should feel good when you first try them on. If you take off new shoes after wearing them a couple hours and find red, sensitive spots, don't wear them again.
8. Buy at least two pairs of supportive, comfortable shoes. Each pair will likely have different pressure points on your feet, so it will relieve the pressure when you alternate wearing different shoes. It will also allow your shoes to dry and air out when you don't wear them every day.
9. In some cases, the cost of special shoes is covered by Medicare for people with diabetes. You must meet certain criteria -- such as foot deformities, past foot ulcers, or calluses that can lead to nerve damage -- and must have a doctor's prescription. Talk to your podiatrist or primary care doctor for more information.”

The above is a reason everyone with diabetes should see a podiatrist at least yearly, if not quarterly to have their feet examined and problems found early and corrected.

If you find shoes that fit correctly, wear them at all times – except when sleeping. Do not go barefoot, even around your own house. This is where most problems start for people that have neuropathy or other foot numbness, as they don't feel anything when they step on something sharp and injure themselves. Then the area becomes infected and problems start.

Now one final word of advice, before you opt for the overly uncomfortable shoes on special occasions, talk with a podiatrist first. Let the podiatrist tell you if these shoes can be worn for short periods of time like that special party. If the podiatrist advises against this, do follow the directions as it is your feet and you don't want to see the doctor later to correct the damage you could have prevented.

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