With so much emphasis placed on proper diabetic footwear, especially for those who suffer from peripheral neuropathy, patients with diabetes may not realize how crucial the size, fit, fiber, and construction of socks also are. Since socks are an integral part of treatment, the following do’s and don’ts may help practitioners educate patients about proper sock selection and wear.
Do prescribe specially constructed, seamless socks that have a soft, flexible, and stretchy toe area where the material is joined.
Do advise patients of the dangers of wearing socks with any irregularities, including darned socks or socks with holes. A seam, wrinkling, or a tiny fold can generate friction, creating microtrauma that can lead to ulceration and worse.
Do prescribe socks made of high quality fibers. They will last longer and wear evenly, instead of leaving thin spots where friction can occur.
Do look for socks made of stretchy synthetics with moisture-wicking properties to minimize the risk of infection and blisters. Any natural fibers should be blended with synthetics and make up a small portion of the total fiber content.
Do choose socks with antibacterial properties. Socks made with silver and copper fibers have been shown to decrease bacteria and combat foot odor.
Do pay attention to fit. Good diabetic socks conform to the foot and resist wrinkling inside the shoe. The best therapeutic socks fit no more than two shoe sizes and offer a range of four or five sizes to choose from.
Do prescribe therapeutic socks with silicone padding to reduce plantar pressure in patients with neuropathy. The padded socks are also a good choice for diabetic patients with rheumatoid arthritis. Double padding can be achieved by wearing two pairs of the socks, one inside the other. To accommodate the extra thickness, the shoe size needs to increase by at least 1/2 size, or suggest the patient wear the socks with extra-depth shoes.
Do make sure patients buy an adequate number of pairs to avoid the temptation to wear the same socks twice or revert to nondiabetic socks.
Do ensure that socks are not causing callus buildup or corns. According to Doug Richie, DPM, of Seal Beach Podiatry Group in Seal Beach, CA, much ulceration occurs beneath pre-existing calluses on the bottom or sides of the foot. “The presence of a callus or corn on the surface of the foot should be a warning sign that abnormal skin shear is occurring,” he said.
Do tell patients how socks fit into their preventive care plan. “Share the results of your evaluation and your strategy for preventive care. Patients who find themselves in the high-risk category for ulcers and amputations should know that wearing properly sized prescription shoes and socks as well as visually inspecting and washing feet every day are all necessary to avoid infection,” said Mark Hinkes, DPM, who is associated with Vanderbilt University in Nashville, TN, where he treats VA patients, many of whom are diabetic.
Do tell patients who develop an infection not to wear socks until they’ve laundered them with bleach or another disinfectant.
Do stress the importance of regulating blood glucose, exercising, and quitting smoking to minimize the risk of foot ulceration and improve healing.
Don’t prescribe socks that are too tight for patients with poor circulation. “If the patient has vascular disease as well as neuropathy, the socks need to have the capability of expanding as the foot and ankle swell,” Hinkes stressed. Special nonbinding socks are available.
Don’t prescribe socks that are too loose. They may bunch up, causing friction.
Don’t use socks with metallic fibers to treat infections or ulcers. “Just because the sock itself resists bacterial growth does not mean it has been demonstrated to reduce infections on the surface of the foot,” Richie said.
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