Proper footwear is one of the essentials for people suffering with diabetes. Just as the rest of their body requires special care, the feet must also be kept in good condition.
This allows them to maintain a normal lifestyle. Diabetic shoes can be defined as customized footwear that are specifically designed for people who battle with diabetes.
Diabetes patients are usually at a high risk of developing foot infections. Most of these infections begin as a wound that eventually develops into a neuropathic ulceration.
Although proper management can lead to the cure of most wounds, sometimes, improper therapeutic approaches can lead to amputation or death.
Other factors that lead to the development of foot infections among diabetes patients include immunopathy, neuropathy, and vasculopathy.
In most cases, infections manifest inform of wounds that are characterized by pain, indurations, tenderness, erythema and warmth.
Systematic infection symptoms such as vomiting, night sweats, anorexia and nausea can also be experienced.
Although there are many types of diabetic foot infections, this article will focus on foot ulcers and gangrene and how footwear can help in the prevention and management of the same.
Vast research has proven that footwear is among the leading external factors that contribute to the development of foot ulcers in individuals suffering with diabetes.
In addition, shoes can lead to skin breakdown and other foot diseases in diabetics.
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Diabetic Foot Ulcers: Its Causes and Challenges
With the dramatic increase of diabetes patients in the global health sector in the recent years, cases of diabetic foot ulcers have also risen significantly.
Various epidemiological studies have revealed that between 1985 and 2010, number of detected diabetes mellitus cases increased from 30 million to 285 million(Yazdanpanah, Nasiri & Adarvishi, 2015).
The studies also provided estimates indicating that the figure is likely to shoot to approximately 360 million by the year 2030.
In a report released by the World Health Organization (WHO), it was revealed that at least 171 million individuals suffered with diabetes by the end of the year 2000.
In addition, the reputable health institution predicted that by 2025 the figure will have increased to 380 million (Aalaa et al., 2012).
Subsequently, the significant consequences of this disease (including foot ulcers) will also grow exponentially, thereby affecting the patients, health care providers and the general society in a big way.
According to Bus, Haspels and Busch-Westbroek (2011), foot ulceration is among the long-term complications that pose dramatic negative implications to diabetes patients.
Primarily, foot ulcers affects individuals suffering with diabetes mellitus. It has a prevalence rate that ranges between 4% and 10% among all patients who suffer with diabetes mellitus.
Overall 15% of individuals diagnosed with diabetes develop foot ulcers at some point in their lives (Yazdanpanah, Nasiri & Adarvishi, 2015).
Today, diabetic foot ulcers is one of the most common causes of hospitalization among diabetes patients. It is linked to severe consequences including lower extremity amputations, infections, gangrene and in some cases, death (Yazdanpanah, Nasiri & Adarvishi, 2015).
Furthermore, when foot ulcers develops, the body becomes exposed to increased risk of progression of the same. In most cases, this eventually leads to amputation.
Normally, the risk of lower limb amputation is 15 times higher in diabetes patients than in individuals suffering from other forms of health conditions.
For every 30 diabetics with foot ulcers, one case of leg amputation is usually reported worldwide (Yazdanpanah, Nasiri & Adarvishi, 2015).
In addition foot ulcers is very effective against stable psychological and mental health. Firstly, it makes its victims physically unproductive thereby destroying their quality of life.
It then leads to financial losses through two ways. In the first and also the primary case, substantial amount of money is lost through medical bills.
In the secondary case, the patient experiences physical pain and other forms of damage that hinder job effectiveness. Therefore, the victim is forced to quit work.
Emotional and psychological damage mainly results from the financial burden experienced by the victim. In addition, it can result from amputation and other severe consequences that go hand in hand with diabetic foot ulcers.
Sometimes, psychological distress can create the need for rehabilitation. Ultimately, this becomes another burden to the victim and the affected family.
Gangrene is another condition that commonly occurs in diabetic foot. Gangrene is a health condition associated with necrosis caused by lack of proper circulation, injury and infection.
Accordingly, the tissues that become depleted of oxygen end up dying. Diabetes mellitus is characterized by numerous foot problems that can lead to gangrene.
Gangrene is classified into three categories that include wet, dry and gas.
Dry gangrene is very common among diabetics and it can affect the hands, or the feet and in some cases both. Its lead cause is poor circulation, primarily attributed to the impairment of the arteries in the affected area.
As a result, the affected tissue become extremely dry and start to experience color change. The color ranges from purplish-blue to blue.
Although infection is an uncommon feature in dry gangrene, sometimes it can get infected thereby leading to wet gangrene.
Wet Gangrene occurs when bacterial infections occur in body tissues. The affected tissues begin to breakdown and die as a result of becoming moist.
Wet gangrene is very dangerous because it can spread the infections from the affected area to other parts of the body. Additionally, it can easily develop in tissues that have experienced trauma and injuries from burns and other problems.
The slight tissue impairment caused by such problems can rapidly affect blood circulation thereby causing tissue death.
Gas gangrene is the least common but the most dangerous. It develops when infections develop in the internal organs of the body.
For example, it can affect the internal of the muscles as a result of trauma. Ga gangrene is linked to a bacteria referred to as clostridia that releases poisonous toxins that get trapped in the body tissues.
The main symptoms of gas gangrene include grayish or pale skin and a crackling sound when the skin is pressed. Gas gangrene requires immediate medical intervention because it can lead to death as soon as two days after infection.
Lastly, there is a less common type of gangrene referred to as Fournier’s gangrene. It occurs when gangrene related infections develop in the genital areas.
Fournier’s gangrene can lead to death and it is common among men. It develops to a condition referred to as sepsis once it gets into the blood stream.
An infected person can experience a variety of signs symptoms depending on the type of gangrene that has developed in the affected areas.
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Dry Gangrene Symptoms
- Coldness and dryness in the skin
- Pain ( Although sometimes it might not occur)
- Skin dryness
- Change in skin color ( With the color ranging from bluish-purple to black)
Wet Gangrene Symptoms
- Swelling in the infected area
- Fever and body weakness
- Bad smelling sores and blisters ( the infections might begin to discharge pus)
- Skin redness ( sometimes the skin can become brown or black)
Overall, here are the symptoms that indicate that you have one of the various types of gangrene
- A wound that is constantly producing bad smelling pus.
- Feeling coldness or numbness in a particular part of the body.
- Having a wound that begins to swell and change in color
- Low blood pressure and prolonged fever
- Unusual change of color is a specific part of your skin
- Unexplained and recurring sores in a specific part of the body.
- Breath shortness
- Abnormally increased heartbeat
- Skin paleness
- Changes in body temperatures
- Development of rashes in the body
The Footwear Challenge
Footwear is amongst the major causes of diabetic foot ulcers. For instance, inadequate coverage of the feet can be very dangerous.
Additionally, foot ulcers can also develop if the shoes worn by the patient cause excessive pressure on some areas of the feet.
This can be proven by the fact that the injury occurs in the pathways when a sensitive foot is subjected to pressure or minor trauma (Reiber, et al., 2002).
Research shows that 85% of the diabetic foot ulcers and amputations can be prevented by proper foot care.
Diabetes patients should be equipped with the necessary knowledge so that they learn how to take care of their feet appropriately.
When it comes to diabetic shoes, different forms of footwear serve different purposes. Whereas some patients require personal custom-made shoes, there are others who can use retail footwear successfully.
Minor modifications can also be made on existing footwear to match the needs of a patient. Such shoes are known as modular orthopaedic footwear.
Various researchers associate ill-fitting shoes with toe ulcers and minor injuries on other parts of a foot. In fact, the likelihood of undergoing amputation as a result of an ill-fitting shoe is very high.
Neuropathic foot ulceration can only be prevented through the use of well-designed shoes.
To address the challenge of foot problems in diabetes patients, a multidisciplinary approach has been adopted by some of the teams that provide footwear.
In other words, this is where orthopedic surgeons, infectious health problems specialist, podiatrists, shoemakers, and vascular surgeons among others come together and combine their knowledge so that they can develop the most appropriate shoes for diabetes patients.
This approach has been significantly successful in preventing foot ulcers and other foot-related health problems in diabetes patients.
In fact, research proves that cases of amputation among diabetes patients have decreased in many countries throughout the word.
Moreover, it is likely that this approach is more effective than other forms of treatments applied by physicians.
The multidisciplinary approach focuses on the fact that walking is fundamental for all human beings including diabetes patients.
Under normal circumstances, each adult takes about 8,000 to 10,000 steps every day. However, if the person taking this steps is a diabetic “with neuropathy with loss of protective sensation “the chances of developing foot ulcers and is very high.
Just like foot ulcers, the choice of shoes can be effective in preventing gangrene in diabetic foot.
The nature of shoes and their accessories determines whether the feet are prevented from injuries and trauma that can lead to infections and development of gangrene.
Patients are advised to avoid high-heels, open shoes and tight shoes.
Shoe choice is a part of foot care routine that can prevent a condition known as atherosclerosis among diabetes patients.
This is where the arteries harden or thicken abnormally. Atherosclerosis can lead to the development of complications such as gangrene.
Related articles; best shoes for women with diabetes and best shoes for men with diabetes
Are Therapeutic Shoes of Real Benefit to High-Risk Patients?
Nowadays, people have increasingly realized that manufacturers are developing ineffective products and marketing them at high prices with the aim of acquiring unnecessary profits.
As a result, people suffering with different health concerns have become cautious and are afraid of trying new products. This is one of the factors affecting the usability of diabetic shoes.
Consequently, this section evaluates comprehensively, the health benefits associated with this kind of footwear.
Essentially, the provisions provided by different health services units’ worldwide show that prescription footwear should provide health benefit such as comfort, improved well-being, protection and improved morbidity.
According to Bus, Haspels and Busch-Westbroek (2011), one of the benefits associated with diabetic footwear is pressure relief.
Unlike nontherapeutic footwear, diabetic footwear is designed in a manner that reduces the risk of plantar foot pressure.
It is important to note that, the risk of developing diabetic foot ulcers increases with increase in plantar foot pressure.
Besides the choice of footwear, here is a list of other things that diabetes patients can do to keep their feet healthy.
- Visiting a podiatrist occasionally: It is always important for diabetics to visit a podiatrist at least once or twice every year. A podiatrist will put you on a foot care regime that is fits the condition of your feet. In addition, he or she will inform you whether special shoes are necessary. Ensure that you make the necessary arrangements to cover these visits in your insurance plans becomes sometimes finances can be a big challenge.
- Check your feet on a daily basis: Diabetic foot is prone to injuries and infections. Always check your feet to ensure that there no cuts, burns, sores swellings, calluses, blisters and other infections that are left untreated for a long time. You can ask your partner or kids to help you and check and massage the feet occasionally.
- Wash your feet every day: Always avoid hot or cold water when washing your feet. Use warm water to gently wash your feet. Sometimes, diabetic foot can be insensitive to hot water. Always use your hands to check the temperature of your bath water. Rinse your foot thoroughly especially between the toes.
- Avoid walking bare foot: Walking barefoot exposes your feet to a lot of risk injuries. For example, you can step on sharp objects such as needles. You can also pump into stones and other hard surfaces that can cause wounds. Eventually, these wounds can develop to health complications that you would have never expected.
- Ensure that your skin is always smooth and supple: Develop a habit of applying moisturizer on your skin after showering. Use a moisturizer that is rich in natural products to ensure that your skin experiences maximum benefit. This will make it firm and less prone injuries and infections. Avoid leaving traces of lotion between your toes because the wetness can easily cause infections.
- Avoid interfering with infections such as blisters and cones: You can be easily tempted to interfere with these kind of infections. You might find yourself using sharp objects to cut them. It is always advisable that you consult your podiatrist for best treatment. Resist the temptation to use over the counter products.
- Avoid exposing your feet to excess cold or heat: Maintaining the right temperature for your feet protects you from a lot of unforeseen problems.
Bus, S. A., Haspels, R., & Busch-Westbroek, T. E. (2011). Evaluation and optimization of therapeutic footwear for neuropathic diabetic foot patients using in-shoe plantar pressure analysis. Diabetes care, 34(7), 1595-1600.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World journal of diabetes, 6(1), 37.
Aalaa, M., Malazy, O. T., Sanjari, M., Peimani, M., & Mohajeri-Tehrani, M. R. (2012). Nurses’ role in diabetic foot prevention and care; a review. Journal of Diabetes & Metabolic Disorders, 11(1), 24.
Reiber, G. E., Smith, D. G., Wallace, C. M., & Vath, C. A. (2002). Footwear used by individuals with diabetes and a history of foot ulcer. Journal of rehabilitation research