Shoe Smarts

The current guidelines on nonprescription footwear for people with diabetes need to be carefully reevaluated, according to a recent study. The study asserts that the relationship between severe foot lesions and “improper” footwear is actually quite weak.

Recommendations for proper, nonprescription footwear for people with diabetes range from Oxford-style lace-up shoes to running shoes.

However, the current study, published in the February 1997 issue of Diabetes Care, notes that very little data support such recommendations. Still, foot management programs continue to educate people with diabetes about the importance of “proper” footwear without clearly defining it.

Surprisingly, “the results of this study suggest that … (in the group studied) the type and quality of nonprescription footwear seem to make little, if any, difference in the prevention of foot lesions, even for patients with insensate feet.” (The study does not take into account the possible benefits of orthotic inserts or running shoes.)

Arnie Davis, a certified pedorthist from San Francisco, says that while this may be true, he wants to make sure that people do not de-emphasize the importance of professionally designed and fitted prescription footwear. He says that because the consequences of improper foot care are so serious (possible amputation) it is better to be safe than sorry.

“The importance of professional shoe fitting for people with insensate feet cannot be overestimated. A certified pedorthist is trained to properly fit those affected by diabetic neuropathy,” says Davis.

He adds that the Medicare Therapeutic Shoe Bill, passed in May 1993, will reimburse people for 80 percent of the cost of one pair of therapeutic shoes per year.

The need for prescription footwear for those with insensate feet is still very real. However, the authors of the study recommend that the current and widely disseminated guidelines on nonprescription footwear should be carefully reevaluated in conjunction with further research investigating the physiological causes of foot lesions for people with diabetes.

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