Your patients cannot open a newspaper or magazine without reading about the dangers of wearing flip-flops. With summer upon us, the lure of “open air” shoe gear is appealing to many. Of course, as podiatric physicians, we also emphasize the dangers of these shoes, especially for our patients with diabetes who are at risk for road debris and foreign objects to be swept up under their feet between the surface of the sandal and the soles of their feet.
While that risk cannot be overcome with any open shoe, there is a difference between a flip-flop and a sturdy sandal. We need to explain the differences to the patient with examples on hand.
My biomechanics friends will rightfully point out the shortcomings of sandals and I agree. However, when you are practicing in San Antonio, the bottom line is even the patients with diabetes are going to wear “chaclas,” sandals. At the very least, I am going to guide them toward the best version of these that I can find.
For my indigent patients, this meant sending them to the Goodwill stores in the more affluent neighborhoods to seek out gently used pairs of Tevas, Reefs, Clarks or other good brands that had features like a raised heel cup and a sturdy sole (with no excessive medial/lateral heel wear). It was not a perfect solution but it was better than the dollar store flip-flops they had been wearing before.
What about the diabetic shoes that I had prescribed for these patients? Those were at home in a box and would only be worn for “special occasions.” Apparently, going to see the podiatrist was not a special enough occasion.
Of course, there are the current “diabetic sandals” that are marketed but they are shoes with a few dorsal cutouts. I would like to pose a question to the biomechanics specialists and my fellow diabetic wound care colleagues. Given the fact that we know our patients will indeed wear true sandals, would any company ever design a diabetic sandal with true dorsal exposure or would it just be too much of a liability?
I look forward to seeing your comments.