Approximately 18.6 million people worldwide are afflicted by diabetic foot ulcers each year. Of this number, 1.6 million reside in the United States.^[1] With the incidence diabetic complications on the rise, it is important for patients diagnosed with the disease to pay close attention to shoe gear selection to prevent the development of foot ulcers and promote happy and healthy feet.

An estimated 25% of patients with diabetes mellitus face impaired wound healing which often results in lower limb amputation and an accompanying psychosocial and economic cost.^[2] Because hyperglycemia (high blood sugar) slows down wound healing, it is important to have preventative measures in place to prevent blisters and other abrasions from evolving into dangerous and painful foot ulcers. With this in mind, finding properly fitting shoes and socks is integral to ensure that diabetic feet have a snug and comforting home they can return to, day in and day out. The initial step is choosing suitable, specially designed footwear and being mindful of what to avoid during your search. Here are some simple pointers for shopping for diabetic-friendly shoes and socks.

Avoid: Most off the Shelf Running Shoes

One of the key barriers in finding diabetic footwear is that traditional retail shops cater to mass interests or needs and so being forced to grab a pair off the shelf leaves a diabetic vulnerable to choosing apparel which compromises their health.

A standard running sneaker will often be designed to be tight fitting to avoid slippage when running or performing daily tasks. This same principle poses issues when looking for diabetic footwear because that same snug fit can restrict blood flow to the skin causing tissue injury which may again cause a wound to develop. Additional pressure buildup can occur in the foot foot from the lacing pattern or mechanism which is designed to hold the shoe steadfastly to the foot. When these restrictions work in conjunction with the sensory loss, numbness, pain, or burning sensations affiliated with peripheral neuropathy—of which diabetics are prone to— this creates a recipe for disaster which includes the dire consequences mentioned earlier.^[3]

Aside from being tight fitting, many standard running shoes do not offer much in terms of depth which often coincides with a lackluster insole and the inability to put in custom orthotic insoles as needed. Custom designed or diabetic insoles are crucial to protect the foot and support proper circulation to reduce the occurrence of foot ulcer development.

Avoid: Compression or Seamed Socks

The prevalence of modern socks to boast that their compression technology boosts athletic performance is something that should be avoided entirely when searching for socks to fit the diabetic foot. The only exception may be the use of graduated compression socks as recommended by your physician. These medical grade compression garments work to reduce swelling in the feet and legs by being tighter at the ankles and loosening as they go up the leg. However, given the margin of error for these socks to be too tight, it may be best to avoid these entirely unless fit by a medical professional and seek out alternatives.

Certain decorative or inexpensive socks can be manufactured in a way which produces a seam running down the foot or along the toe line. This is to be avoided as gradual irritation and moisture buildup in this area can leave the foot prone to blisters or abrasions which can cascade into ulcers or infections.

Another trait to be cautious of when seeking out socks is that of heavy cotton (or similarly thick materials) which, while often breathable and comfortable, have a tendency to retain moisture. This can spell danger to a patient with diabetes given that moisture retention can create a damp environment which leads to fungi or bacteria buildup.

Instead: Seek Out Diabetic Friendly Footwear

While it can be daunting to find the right footwear, options that are specifically designed for patients with diabetes have been around for some time. These options have progressed steadily since their inception, allowing for peace of mind when seeking out a safe choice.

When searching for diabetic shoes, here are some guidelines to use when evaluating your options. Focusing on these four aspects: fit and comfort, support and cushioning, breathability and material, and a seamless material coupled with protective features will help you choose the best shoe for you.

Fit and Comfort

A properly fitted shoe for the diabetic foot would be neither too tight nor too loose but would allow the foot to sit freely with the slightest bit of give. It is also best to have shoes with a wide toe box so that the toes do not get constricted in the narrower ends of the shoe (as may occur with the more tapered mainstream running shoe). This design helps prevent blisters or calluses from forming at key pressure points in the foot which are often pressed against the inner sides of the shoe. When looking for fit and comfort, see that the shoes are either fitted to your foot or otherwise allocate enough room for the foot with no noticeable pressure buildup appearing throughout the shoe.

Support and Cushioning

A diabetic friendly shoe will feature a specially designed insole profile or would delegate enough room at the bottom to accommodate custom made or off the shelf orthotic insoles. These insoles reduce plantar loads or foot pressures which is one major mechanism to prevent foot ulceration.^[4] The standard profile offered in diabetic shoes is that of the “rocker profile” which provides ample support in the middle arch of the foot to address biomechanical gait issues or may double as treatment to musculoskeletal disorders.

Breathability and Material

Given that patients with diabetes have a predisposition to develop foot wounds even after a sight of trauma, it is important to seek out shoes with material which allows for maximum breathability. Materials common to diabetic shoes' outsoles and exterior include foam, leather, canvas, occasionally integrated gel. Depending on the manufacturer, these materials work together to provide shock absorption and the wicking of moisture to prevent bacteria buildup.

Seamless Material and Protective Features

Key to any diabetic shoe search would be to ensure that the shoe’s inner lining is free of abrasive seams or edges which render the diabetic foot prone to scratches, scrapes, or blisters. True diabetic shoes will have a soft and smooth interior. Many diabetic shoes do away with laces in favor of a simple slip in design or otherwise offer velcro or other simple straps in order to prevent over-tightening.

Final Thoughts

When considering your health, even the smallest of things matter. So, it can be important to take care of your little appendages because the smallest slip ups can form into big issues for patients with diabetes. Be sure to put these tips into practice as you search for diabetic friendly footwear and take care to show some love to your feet.