Cath Lab Digest

For patients with diabetes, proper footwear is a critical part of the equation for preventing or reducing the risk of lower extremity complications. Accordingly, this author offers pertinent pointers and key nuances in ensuring the proper fit of therapeutic shoes.

   The number of people diagnosed with diabetes has doubled since 1996, according to the Centers for Disease Control and Prevention (CDC).¹ In 2009, approximately 4 million people with diabetes mellitus will develop a foot ulcer.¹ The ramifications of this fact are enormous and the effects are far reaching just within the podiatric profession alone.

   Foot ulcers will require a myriad of treatment options from conservative care to surgical intervention. Regardless of whatever training and expertise the treating physician has, the common goal is a healed wound. An even more difficult goal to attain, but one we all strive for, is wound prevention.

   That is where shoes enter into the discussion as an integral part of the treatment plan. For many individuals, shoes are just a necessary covering for the feet. For others, shoes can simply be a fashion statement. Once an individual develops a foot problem, the shoe takes on a whole new meaning. In these situations, the shoe becomes a medical device. Fortunately, the awareness of the therapeutic impact of shoes is growing within our profession. This is critical in helping all of our podiatric patients, but especially those with diabetes.

   In 1993, the Therapeutic Shoe Bill took effect. Since then, the awareness of this bill has grown among treating physicians as well as the Medicare beneficiary population. The underlying concept behind this legislation was and remains prevention. There are few services in medicine today that are focused solely on prevention. In fact, most of medicine seems to be geared toward disease management instead. The fact that we have this resource available to help our patients is one that we should promote every day in every podiatric practice.

   A study published in Diabetes Care looked at the total cost of providing therapeutic shoes to Medicare beneficiaries. The authors of the study concluded that providing this benefit would not increase the cost of this Medicare sponsored program.²

   Furthermore, several studies have shown repeatedly that therapeutic footwear reduces the rates of ulceration and re-ulceration.^3,4Patients with peripheral neuropathy, peripheral vascular disease and various types of structural deformities, in the presence of diabetes mellitus, are at high risk for complications. Getting these patients into appropriate footwear as soon as possible is imperative.

   In addition, educating these patients with diabetes on the importance of footwear and how it can help them is critical in facilitating their adherence with the overall treatment plan. Sometimes just a pair of shoes can prevent ulceration, infection and even amputation.

Understanding The Dynamics Of Proper Shoe Fit

   Shoe fitting is an art. It is not entirely objective and this makes it challenging. Adding to the challenge is that everyone has an opinion on shoes. There will likely be different opinions on fit and effectiveness, not to mention the added complications of style and color.

   Whether it is the patient’s preconceived ideas regarding footwear or the person fitting the shoes, there has to be an understanding by both parties and a willingness and trust by the patient to be led into the right shoe.

   When it comes to therapeutic shoes, several characteristics directly relate to how well the shoe will fit the foot. To start with, look at the sizing of the shoe. These shoes need to be available in half sizes. While whole sizes allow for smaller inventory, they do not guarantee a good fit.