Why you should check every diabetic’s feet

A study reveals that the vast majority of diabetic patients are wearing ill-fitting shoes, setting themselves up for serious, even catastrophic, complications.

Poor-fitting shoes are a particular concern for these patients because diabetes-related neuropathy may prevent them from feeling a foot injury. A foot ulcer caused by shoes that irritate or put pressure on the skin may progress to a serious infection before the person even notices the injury.

Another common diabetes complication, peripheral vascular disease, can compound the problem by impeding wound healing. Eventually, what began as a minor sore can lead to the need for amputation of a foot or leg. It is projected that 15% of people with diabetes will develop a foot ulcer at some point, with only about half noticing the problem themselves.

In the new study, investigators measured the foot length and width of 100 men and women (mean age 62) attending a diabetes clinic in Scotland. Feet were measured once while was sitting and again while standing. (Standing can flatten the arch, lengthening and widening the foot.)

Approximately one third of the study participants had a shoe that fit at least one foot well, either while sitting or while standing. But only 24% had a pair of shoes that were of appropriate length and width while sitting. That figure dropped to 20% once people stood. Only 17% of the group wore shoes that fit well during sitting and standing. The most common fit problem involved shoes that were too narrow.

Among the participants, 7% had foot ulcers, 15% had calluses, and 10% had bunions.

The researchers pointed out that because the shape and size of feet can change, adults should have their feet measured regularly rather than purchase shoes based on an outdated measurement. In addition, “Education and daily inspection of feet is essential to patients with diabetes,” they concluded (Int J Clin Pract. 2007;61:1900-1904).

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