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Education Material for Health Care Professionals: Book Version



This is one of the most important areas in preventing trauma to the feet, Unfortunately, this is an area where one comes across the most obstinacy. People having diabetes should never walk barefoot. I am against the use of even chappals ( sandals) for use by a diabetic. These really afford no protection against trauma. Unfortunately, many patients refuse to change over from wearing these chappals inspite of all persuation, saying that the use of shoes is not only uncomfortable but goes against their traditional dress style. In such cases, one compromise would be to insist that the chappals should be stitched and not have any nails in them. It is obvious that these patients would need to be extra careful about any injuries that they may get.

Women also rebel against the use of shoes, but this is an argument that does not hold good especially in urban areas where excellent shoes for women are routinely available. Another argument that is used is that the shoes that the doctor feels are good for the feet are not fashionable enough. This may be true in many cases as unfortunately, the arbiters of fashion do not take into consideration the skin condition of a diabetic. At the same time decent looking shoes are available for women which may not be in the height of fashion but are nevertheless quite good looking and suitable for wearing by a diabetic.

Let us now come to the type of shoes that should be worn. They should be made of soft leather rather than of any other synthetic material.

Buy shoes at the end of the day, when the foot is usually at its largest (because of swelling). Shoes will be more accurately and safely sized at that time. All shoes should be sized while the patient is standing since the foot increases in length and width when it is bearing weight. Shoes should be approximately one-half inch longer than the longest digit when sized while the patient is standing.

They should be big enough to accommodate the foot spaciously, especially the front part which should not bunch up the toes.

Many patients feel that such spacious shoes make them look awkward and have a tendency to choose shoes that are a size too small. Advise the patient to make an imprint of their feet on a piece of paper and the shoes that they buy should be broad enough and long enough to completely cover the imprint. This should be done for both the feet Often there may be slight variations in the two feet and what may be all right for one foot may cause the same size shoes to be slightly tight for the other foot. In this case, one would either have to get shoes of different sizes or have shoes specially made for them. This may also have to be done by others who have special problems like cocked up toes, high arches of the feet or other structural deformities.

Shoes should have uppers made of soft leather. The soles of the shoes should also be of leather since rubber (or other synthetic) soles do not offer adequate protection. How often have we seen thorns or nails push right through the rubber soles. Shoes should be stitched rather than nailed together. The soles and the insides of the shoes must be closely examined before the shoes are put on everyday. One would be surprised by what may be sticking out through the soles or even be embedded inside the shoe.

All new shoes even if they are spacious, need breaking in. New shoes should never be worn for more than an hour at a time. What this implies is that one should not wait till the last minute before getting new shoes. Advise patients to keep two pairs of shoes so that the other pair can be comfortably worn in an emergency.

If these simple guidelines are followed, the chances of preventing serious foot problems from developing would be very bright. Many patients may feel that one is being unduly finicky about the need for excellent foot care. But having seen so many patients with serious foot problems and the morbidity associated with this, one would agree that there is no better treatment than prevention. After all, the old saying:
“For want a nail, the shoe was lost;
For want of a shoe, the horse was lost;
For want of a horse, a war was lost.”

……….should not come chillingly true for the patient!