Types of footwear: Almost every diabetic footwear treatment includes some sort of deep waist shoe. Traditional deep-waisted shoes are of the Oxford type and have an additional waist depth of 1/4 to 3/8 of the full shoe height. When the removable lining is removed, the shoe has an even deeper waist. The larger space in a deep waist shoe is ideal for diabetics because it can accommodate a foot support or ankle support without compromising the comfort of the shoe. The larger space in the shoe facilitates deformities associated with diabetic foot, such as hammertoe or bony prominence due to Charcot’s arthropathy. In contrast, commercial shoes for diabetic foot tend to be of varying widths. In the treatment of diabetic foot, other features of deep-waisted shoes include shock absorption, lighter mass and a sturdier upper. The uppers of deep-waisted shoes can be made of different materials, including cowhide and soft deerskin. Some shoes have a soft and malleable lining when heated, which allows the leather to be heated and moderately extended. There are also new man-made materials used in the production of uppers, which are breathable and look like leather products. The latest advances in deep-waisted shoes are now focused on the elasticity of the upper.
There are many athletic shoes that are considered deep waist shoes, they have removable insoles, have different widths, and are more aesthetically pleasing and therefore more acceptable compared to traditional oxford type shoes.
Commercial shoes do not fit well mostly because of severe foot deformity or a large difference in size between the left and right foot, which requires modification of the shoe, and if the modification is unsuccessful, the last option is to use a custom-made shoe, which involves first taking a mold of the foot and later making the shoe according to the model. This way the shoe is made to match the shape of the patient’s foot, thus providing optimal comfort and thus protecting the foot. Of course, compared to commercial shoes, custom-made shoes are more expensive and lack aesthetics, which makes them less acceptable to patients.
How to choose shoes Shoe selection depends on three basic conditions: the patient’s physical condition, the shape and characteristics of the foot, and the patient’s daily activities.
For patients with no history of foot ulcers, no peripheral neuropathy, and normal foot structure, a commercial shoe with appropriate materials and good comfort is sufficient; if the patient has neuropathy, a history of foot ulcers, Charcot’s arthropathy, or an amputated toe, more specific foot protection is needed; when selecting shoes for patients with severe neuropathy, a shoe with a soft, malleable upper material should be chosen, and there should be There should be enough space inside the shoe to accommodate traditional orthopedic braces.
The shape and characteristics of the foot are also very important for shoe selection, and the chosen shoe should be compatible with the foot structure. Larger patients should use solid, well-constructed shoes that do not break quickly, while smaller patients should use relatively lighter weight shoes.
The shape and size of the foot is diverse, and so should be the shoes, of which the most critical issue is – the shoes chosen must fit the shape of the foot and its characteristics. In addition to fitting, a properly fitting shoe should have sufficient depth to accommodate additional support (foot orthotics or ankle orthoses). In short, the shoe must match the type and shape of the foot. If the patient has extremely flexible flat feet, a shoe with firm support should be used; if the foot has hard calluses or bony prominences, a shoe with a soft sole should be used in order to absorb shock.
The shape of the shoe depends on the sole, which comes in a variety of shapes, and the manufacturer will choose the appropriate sole for the particular application, so a size 7 shoe made by company X will be significantly different from a size 7 shoe made by company Y. The size, shape and width of soles used for foot treatment vary, and may be tapered, round or square, in addition to inflare, outflare, long-toe or short-toe soles, in addition to soles that can be made into a joint type, such as a heel that is significantly narrower than the forefoot, allowing the forefoot enough room to move while ensuring the comfort of the hindfoot.
In the toe and instep position, the depth of the shoe is very important and in principle should not create pressure in the above position. Generally speaking, shoes with laces or buckles are better than Slip-on
shoes, as the latter are tighter and shorter in design.
The patient’s occupation, movement and the surrounding environmental factors also play a role in the choice of shoes. Certain special jobs require steel-toed safety shoes or safety boots, while certain jobs require formal dress shoes.
Choosing the Right Fit After correctly selecting the type of shoe, the next step is to decide on the proper size of the shoe. There are several devices that can be used to evaluate shoe size, with the Brannock device being the most complete, measuring the length of the full foot, the length of the arch (ankle to ball of foot) and the width. If the shoe is properly sized, the first metatarsophalangeal joint can comfortably land in the most spacious area of the shoe, which is the purpose of measuring the arch length.
Foot measurements should be taken in both weight-bearing and non-weight-bearing conditions to understand the degree of change in foot shape and size in both situations. Also, both feet should be measured because most people have different sized feet and if this difference is significant, you are likely to end up with a pair of shoes that don’t look quite right.
Foot measurements are taken by any method in order to know the size of the foot, however, the result is not necessarily the size of the shoe. It also requires the orthopedist to have a good understanding of each shoe, how each shoe fits, how each shoe size matches the foot size, and the characteristics of each shoe’s fit.
What is a good-fitting shoe? ① The longest toe should have 3/8~1/2 inch of clearance between the end of the toe and the front of the shoe. ②The ankle joint has the right amount of space for movement because the foot has some extension and displacement of the heel bone during walking. ③The upper should not be tightly wrapped around the foot, but should be made of a fairly loose material.
Properly fitting shoes are critical to preventing foot disease, but many people have shoes that do not fit. Therefore, it is important to educate the public and make them understand “how to choose shoes that fit”.
Foot orthotics will be discussed in the next section. Many people focus one-sidedly on foot orthotics, but it is important to note that knowledge of shoes is just as important as knowledge of foot orthotics.