Foot care is key for anyone with diabetes, especially when you have diabetic peripheral neuropathy (DPN). DPN is nerve damage, most often in your lower limbs.
It can happen because uncontrolled or poorly controlled high blood sugar from diabetes can damage your nerves. This problem can affect other parts of your body, but it’s especially common in your feet.
Problems with blood flow to your feet is yet another thing that can put you at greater risk of foot problems. When you have DPN, what seems like a minor issue, such as a blister on your toe, might lead to much bigger problems.
That’s because your nerve damage (neuropathy) can make it harder for you to feel that you’ve got a blister or sore. And you may have numbness, tingling, or not feel pressure or pain in your feet all the time.
Without treatment, you can get complications and infections.
Each year in the U.S., 160,000 people with diabetes have a lower limb or foot amputated, most often as a complication of diabetes.
But taking good care of your feet long before problems arise can help you prevent these complications. Start by seeing your foot doctor at least once a year for a foot exam.
Another way to protect your feet is to check them each day for any changes. You can also avoid going barefoot and ensure you’re wearing proper footwear, including the right socks and shoes, at all times.
Find out how your shoes can impact your risk of foot problems, what socks to wear, and get tips on how to find the right shoes if you have DPN and are looking at footwear.
How Do Shoes Affect My Risk of Foot Problems?
Foot complications are always a risk when you have diabetes and peripheral neuropathy in your feet. With DPN, not wearing the proper shoes can raise your risk of problems even more.
Shoes that fit you poorly can make sores and blisters more likely. They can even lead to changes in the bony structures in your feet and toes. If you walk around barefoot, you’re more likely to get cuts or sores on your feet, too.
Talk to your care team about how to make sure you’re wearing the right shoes to protect your feet.
What problems can improper footwear cause?
The best shoes for your feet can help lower your risks of potentially serious foot complications. So when shoes don't fit, you can get issues.
Although most people don’t get them, one of the most common issues with diabetes and DPN is foot ulcers. These open sores on your feet happen to about one-third of people with diabetes. And once you’ve had a foot ulcer with DPN, you are more likely to get another one.
You’re also more likely to get an ulcer when you wear shoes that rub your feet over and over again in the same spot. These ulcers can get infected and even lead to amputation of a toe or your whole foot. But choosing the right shoes can help you protect your long-term health and prevent complications.
What can happen if my shoes are too tight?
Shoes that are too tight can lead to a wide range of foot problems or deformities. These issues can raise your risk of diabetes-related complications.
If you notice any changes to the structure or surface of your feet, your shoes may not fit you correctly. These minor issues can lead to bigger problems when you have DPN. Talk to your care team or a footwear specialist for advice.
Do I Need a Footwear Specialist?
If you have a higher risk of foot problems, you may need to see a foot care specialist who can ensure you’ve got the right shoes.
Your doctor may suggest that you see a foot care specialist if you have DPN and:
- Loss of protective sensation (LOPS)
- Peripheral arterial disease (PAD)
- Charcot foot
- Bunions
- Hammer toes
- Other foot deformities
How Can I Choose the Right Shoes?
Talk to your doctor about the best footwear for your feet. Here are a few tips when looking for shoes.
To lower the pressure on any one spot from your shoes, consider buying a few different pairs that fit you well. That way, you can change up which ones you wear from day to day.
Check that you can fit the width of your thumb between your toes and the end of the shoe. Your feet will expand when you’re walking or otherwise in motion.
What Type of Socks Should I Wear?
Along with wearing the right shoes, the right socks are important to keep your feet healthy, too.
Ask your doctor if you should wear compression socks or socks that are specially made for people with diabetes.
Do I Need Orthotics or Prescription Footwear?
Orthotics can be worn in your shoes to prevent pain or pressure when you have conditions, such as:
- Bunions
- Calluses or corns
- High arches
- Hammer toes
You can buy some orthotics at the drugstore or shoe store. Other types of orthotics are custom made for you.
In addition to modifying your shoes or choosing the right shoes, orthotics can help to relieve pressure on your feet to prevent blisters, sores, or other issues, allowing you to walk more comfortably.
Ask your care team if orthotics might help lower your risks of foot complications related to diabetes and DPN.
Custom-made shoes can help
If you have a higher foot complication risk and serious foot deformities, you may benefit from prescription, custom-made shoes. A specialist known as a pedorthist can modify or make shoes and orthotics just for you.
Custom shoes are also made with softer materials that can lower your risk of any rubbing or pressure, leading to foot ulcers or sores.
Are shoes for people with diabetes covered by my insurance?
It’s always a good idea to check with your insurance to make sure you know what’s covered and how much you’ll need to pay out of pocket.
Medicare Part B covers therapeutic shoes when you have diabetes and severe diabetes-related foot disease. Ask your doctor for a prescription for shoes or inserts.
When Should I Replace My Shoes?
When you have diabetes, check your feet daily. If you’re noticing new problems on your feet, it might be that you’ve got the wrong shoes or your shoes need replacing.
Inspect your shoes regularly for signs of wear and tear. Make note of any changes in your shoes, including:
- Rough edges
- Changes in seams or linings
- Soles or heels that look worn down
If you’re noticing signs that your shoes are breaking down, it’s time to get new ones. It’s a good idea to break new shoes in gradually.
Consider buying a new pair before your old ones wear out. That way, you can break in your new shoes a little at a time.
Tips for when you’re buying new shoes
Before buying new shoes, check the size and shape of your foot. Your foot size or shape can change over time.
Because shoe brands change, the same shoes that worked well for you in the past might not offer the best fit again.
Once you get the shoes home, wear them for short periods of about 20 minutes at a time. Take the shoes off and check your feet.
If you notice any issues, such as redness, you may be able to return the shoes for another pair.
What Are Other Ways to Protect My Feet?
Along with wearing shoes to support your feet and socks that fit you well, there are other ways to protect your feet.
Here are a few more tips to keep your feet safe with DPN:
- Check your feet for any changes or problems each day
- Keep your toenails trimmed and smooth
- Put your feet up when you sit down and wiggling your toes
- Keep yourself moving while being gentle to your feet
- Wash and dry your feet daily
- Moisturize the tops and bottoms of your feet, but not the spaces between your toes
- Ask your doctor your to check your feet each time you have a visit
- Don't remove your own corns, calluses, or pop blisters
- Stop smoking
- Skip out on soaking your feet or walking barefoot
- If possible, stay away from high or low temperatures
Questions to ask your doctor
Some questions to ask your doctor about shoes include:
- Am I wearing the right shoes?
- Should I see a footwear specialist?
- Do I need custom-made or prescription shoes?
- How often should I replace my shoes?
- What is my risk of foot complications?
Well-fitting shoes and socks are key when you have diabetes and peripheral neuropathy in your feet. These can help lower your risk of foot ulcers, infections, and even amputations.
The right shoes should be supportive and sized to fit your feet without being too tight. When in doubt, ask your care team, foot care specialist, or podiatrist for advice.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Cleveland Clinic: “Diabetes-Related Foot Conditions,” “Orthotics.”
American Diabetes Association: “Amputation Prevention Alliance,” “8 Tips to Protect Your Feet with Diabetes.”
Peripheral Neuropathy Support Network: "Shoes & Foot Care: How do the right shoes help?"
Pedorthic Footcare Association: “Diabetes & Pedorthics.”
UpToDate: “Overview of management of diabetes-related foot disease,” “Patient education: Foot care for people with diabetes (Beyond the Basics).”
American Academy of Orthopaedic Surgeons: “Tight Shoes and Foot Problems.”
Diabetes Care: “Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes – 2024.”
World Journal of Diabetes: “Orthotic approach to prevention and management of diabetic foot: A narrative review.”
Foot Health Facts: “Diabetic Shoes.”
Know Diabetes: "Footwear Advice."
Medicare.gov: “Therapeutic shoes & inserts.”
