- Patients with diabetes and neuropathy should never walk barefoot because they are at substantially higher risk for puncture wounds when barefoot than nondiabetics.
- Patients with foot ulcers should not wear a show on the affected foot while the ulcer is healing. Even the most ideally fitting prescription shoes will not take the pressure off a wound or ulcer nearly as well as a total contact cast or removable cast walker.
- Before putting on any shoe, the patient should inspect the inside for wear, sharp or irritating seams and stitching, and foreign objects.
- New shoes should be broken in slowly. We typically advise patients to wear new shoes for short periods of time (i.e. one to four hours), slowly increase wear from that point, and inspect their feet frequently. Any signs of irritation should be brought to the attention of physician.
- Buy shoes at the end of the day, when the foot is usually at its largest (because of swelling). Shoes will be more accurately and safely sixed at that time.
- All shoes should be sized while the patient is standing since the foot increases in length and sidth when it is bearing weight. Shoes should be approximately one-half inch longer than the longest digit when sized while the patient is standing.
- The "break" of the shoe, should correspond to the widest part of the patient´s foot (typically at the metatarsophalangeal joints). Heel-to-ball length is as different from person to person as is heel-totoe length and should be taken into account when sizing shoes.
- An experienced shoe fitter should size and fit all patients with diabetes. Patients with sensory neuropathy have a tendency to select shoes that are too small because they are better able to "feel" a tight shoe on the foot.
- Even prescription shoes don´t last forever. The insole should be changed frequently at least three times a year, depending on the patient´s activity level. The shoe should be changed at least once a year as well. Ideally, patients should rotate the shoes they wear and change shoes in the middle of the day, if possible.
- The shoe should be acceptable to both the patient and the physician. However, the most comfortable and accommodating shoe may not be aesthetically or functionally appealing to the patient. Conversely, the most aesthetically appealing shoe may not be acceptable to the clinician.