The main cause diabetic foot injury is the use of unsuitable footwear, which is found to be a trigger cause in approximately 40% of cases. Other less common causes are improper pedicure procedures, thermal injuries, and acute trauma caused by a foreign body.
About half of diabetic patients with foot ulcers have foot deformations, and in 12% the deformity is the direct cause of the injury.
It is essential that each patient identifies and understands the characteristics of their feet, their gait, and the accessories that best serve them.
Knowing how to choose footwear is very important, and footwear for the diabetic foot should be snug and comfortable, should reduce the impact on the base of the foot, and should not produce unsafe and annoying chafing.
Footwear for diabetic patients should comply with the following recommendations:
- Have enough width and volume so that the area containing the toes is not compressed, since any small trauma to the tips of the toes or nails will lead to discharge, which can result in a small abscess and infection. It is not advisable to wear high heels or pointed footwear, nor uncomfortable or tight footwear that rub or hurt the feet. Footwear should be of a suitable width to avoid unnecessary friction and pressure on any part of the foot, but it should not be too wide either, as then it will not hold the foot and the slack will cause rubbing when walking.
- Be a close-toed model in order to cover the toes and heel, which are the most susceptible parts in cases of diabetes, and to prevent dirt or foreign bodies that may cause injuries or cuts from entering.
- During manufacturing, it is important to use quality leather or materials that are both flexible and breathable to prevent the foot from sweating. It should be designed to absorb and facilitate water evaporation, in order to keep the foot as dry as possible.
- It is advisable to change footwear every day, so that the footwear can finish drying before being used again, while this also alternates the foot’s support and friction points.
- The height of the heel should be 2 cm in the case of men and 4-5 cm maximum in the case of women.
- It should be deep enough to accommodate an orthopaedic insole or any foot deformity, if so required.
- It should grip the surface, and must have total or semi-total contact, in order to provide greater stability when walking, and in addition the sole should be hard, thick and made from high density rubber. The heel counter should be sturdy and padded, and should be adapted to the foot of the person who is going to use it, leaving the ankle and ankle area free in order to avoid chafing over the Achilles tendon, as it is an area where wounds or injuries are more difficult to heal.
- It is important that the footwear does not have raised seams on the inside, in order to avoid friction injuries.
Source: Calzamedi
Nowadays, the most important thing in order to ensure that diabetic footwear meets these requirements is to find out if your regular supplier or suppliers have a Health License for Class I Production.
The HEALTH CE mark is the only guarantee for the patient that the product complies with Regulation 2017/745, regulating health products.
When we deliver orthopaedic footwear without this requirement, to meet the requirements of a prescription, we run the risk of treating an item of footwear which is not a health product as if it is.
In the event of a serious incident that places the patient’s life at risk, the Department for Health would request the full tracking history of the product, and this traceability is only possible when the footwear is a health product and bears the HEALTH CE mark.
BIBLIOGRAPHY
- Orthoinfo from the American Academy of Orthopaedic surgeons
- Footcare MD (American orthopaedic foot & ancle society (aofas.org)
- Pie-diabético.net
- Management of type 2 diabetes. New Zealand Guidelines Group; 2003.
- Clinical Guideline. Management of type 2 diabetes: Prevention and management of foot problems. London: National Institute for Clinical Excellence; 2003.
- Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.
- Mayfield JAM, Sugarman JRM. The Use of the Semmes-Weinstein Monofilament and Other Threshold Tests for Preventing Foot Ulceration and Amputation in Persons with Diabetes. Journal of Family Practice. 2000;49(11):S17-S29
- Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA. 2002;287(19):2552-8.
- NIH: National Institute of Diabetes and Digestive and Kidney Diseases: “La diabetes y los problemas d elos pies”.
- Busch K, Chantelau E. Effectiveness of a new brand of stock ‘diabetic’ shoes to protect against diabetic foot ulcer relapse. A prospective cohort study. Diabet Med. 2003;20(8):665-9.
- Clínica Universidad de Navarra.
- Cuidados del Pie Diabético – Grupo Quirónsalud.
