Choose the proper footwear

 Choose the proper footwear - for all

Choosing the right footwear is an important part of foot care, since poorly fitted shoes are involved in as many as half of serious foot problems. Here are some tips for choosing the best footwear:

1. Wear well-cushioned walking shoes or athletic shoes. If you have foot deformities such as hammertoes or bunions, you may need extra-wide shoes or depth shoes. Depth shoes have more room in them to allow for different shaped feet and toes or for special inserts made to fit your feet. If problems are severe, custom-molded shoes are available. Medicare provides coverage for some special shoes; your doctor or foot care specialist can help determine if you qualify.
2. Don't wear shoes with high heels or pointed toes. They can create pressure, which might contribute to bone and joint disorders as well as diabetic ulcers.
3. Don't wear open-toed shoes or sandals with a strap between the first two toes. They increase the chance that you'll injure a toe.
4. When you buy new shoes, be sure your feet are properly measured and fitted. Your feet can change size and shape, so an experienced shoe fitter should measure them whenever you get new shoes. Shoes should fit both the length and width of your foot, with room for your toes to wiggle freely.
5. Your new shoes should be sturdy and comfortable. They should have leather or canvas uppers, which breathe to keep your feet from getting sweaty. Avoid vinyl or plastic shoes, because they don't stretch or breathe.
6. When you get new shoes, break them in gradually so you won't get blisters.
7. Shake your shoes before you put them on. Even a small pebble in your shoe can lead to problems.

Special care for high-risk conditions

If you do have any of the high-risk conditions, there are specific things you should do to keep your feet healthy.

• If you have neuropathy or evidence of increased pressure on the soles of your feet, wear well-cushioned walking shoes or athletic shoes.
• If you have lost some sensation in your feet, be sure to carefully inspect them often to identify any problems early.
• If you have calluses, have a foot care specialist treat them.
• If you have bony deformities such as hammertoes or bunions, you may need extra-wide shoes or depth shoes. In extreme cases, custom-molded footwear may be needed.
• Promptly treat minor skin conditions such as dry skin or athlete's foot to keep them from progressing.
• Have a complete foot examination every 3 to 6 months.

A formal, comprehensive program has been developed at the Gillis W. Long Hansen's Disease Center in Carville, LA, known as the "LEAP program" for Lower Extremity Amputation Prevention. It consists of 5 relatively simple activities:

• Annual foot screening to identify people who have lost protective sensation
• Patient education in self-management, with emphasis on proper foot care
• Daily self-inspection of the foot
• Appropriate footwear selection
• Management of simple foot problems such as dry skin, nail and callus care, and basic wound management

In a number of large clinical centers where formal preventive care programs such as this have been implemented, the rate of amputations has been reduced by as much as 85%.