December 2011

Diabetic shoes: Fashion and function

By Shalmali Pal

Every day, people willingly trade good foot health for stylish shoes—think stilettos, platforms, and pointy toeboxes. For some time, however, patients who wore diabetic footwear didn’t have the option of worrying about style versus substance.

“When I began practicing years ago there was only one style of [diabetic] shoe and you could tell from across the room it was an orthopedic shoe,” said Crystal Holmes, DPM, CWS, assistant professor in the Department of Internal Medicine at the University of Michigan in Ann Arbor.

Fortunately, diabetic shoes have come a long way, shedding, to some degree, their designation as clunky and unattractive, and are now available in a variety of styles and a rainbow of hues.

With diabetic shoes, the trade-off between fashion and function gets complicated. Holmes and Hillary Brenner, DPM, of Tribeca Private Medical Group in New York City, shared advice for balancing patients’ desire for fashion with clinical concerns.

Sources said women tend to be more focused on style than men. As a result, the Mary Jane has become a staple of diabetic footwear lines, and serves as an example of how aesthetic needs must be weighed against patients’ pathology and lifestyle.

On the whole, experts approve of this shoe style. Holmes said many of her patients like its versatility for everyday, special occasion, and professional looks.

The style can make extra depth look relatively attractive and is compatible with foot orthoses when they are needed. Mary Janes come in cloth or leather, which can accommodate foot deformities.

This style does have drawbacks: The strap across the front may not be suitable for patients with edema or bony prominences, Holmes said.

Brenner isn’t keen on the opening at the top of the shoe and insists patients wear the shoes with socks, stockings, or tights.

In addition, Holmes noted, the toebox can be very wide while the heel tends to be narrow, so foot slippage inside the shoe can be an issue, Holmes said.

Experts who talked with LER said they make a priority of discussing the clinical objectives of diabetic footwear with patients first, then move on to lifestyle issues.

“I certainly would not prescribe the same shoe for a 90-year-old diabetic patient who is a community ambulator who just goes to the market or walks around her home as for a 60-year-old farmer who still works daily on his farm,” Holmes said.

But it’s a safe bet the 90-year-old will be more concerned about fashion than the farmer.

Matching the shoes to the activity is also important, Brenner said. For example, a three-hour sit-down dinner may be a chance for the patient to don a less clinically appropriate, but more attractive, diabetic shoe. In contrast, a full day of walking at a museum calls for wearing prescribed footwear.

“You want to avoid completely taking away options from a patient,” Brenner said.

Options are key when negotiating fashion and fit with patients. Often, patients get their diagnosis and assume it means diabetic shoes are their only choice.

“Just because a person has diabetes doesn’t necessarily mean she’ll need the shoe with the extra depth or the rocker bottom,” Brenner explained. “A younger person with diabetes whose blood sugar is under control may not need that diabetic shoe. On the other hand, an older patient with some balance issues will need a shoe that offers stability and support. It’s not one-style-fits-all for diabetic patients.”

If a patient is determined to wear a certain style, Holmes tenders a compromise.
“I say to them, ‘I’ll let you wear this shoe for six months. During that time, we’ll check your feet regularly. If we see any problems—a spot of irritation—then you have to agree that you’ll stop wearing that shoe and wear the shoe that I prescribe for you,’” she said.

Sponsored by an educational grant from Dr. Comfort

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