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& Feet

Canadian Certified Pedorthists – C. Ped (C) - urge Canadians living with Diabetes to make footcare a daily priority. An estimated 2.3 million Canadians currently live with diabetes and 14 - 24 per cent of those at risk of developing a foot ulcer that will result in the amputation of a foot or leg.

Long term complications in people with diabetes frequently manifest in foot problems such as infections and ulcerations that can lead to amputation. In fact, foot problems are the leading cause of hospitalization for Canadians living with the Diabetes.

The majority of foot problems diagnosed in people with diabetes could have been avoided through daily footcare and proper shoe selection. Many people with diabetes have reduced circulation or sensation in their feet (called neuropathy), and are not able to feel if something in the shoe or the shoe itself is irritating their foot causing wounds or ulcers. With this in mind, it is vital for them to visually examine their feet and have their shoes professionally fitted rather than relying on how their feet 'feel' to avoid foot problems.

The Canadian Diabetes Association (www.diabetes.ca) recommends that all people with diabetes should be instructed on proper footcare and have foot examinations at least once a year to avoid the risk of amputation. Foot examinations should include an assessment of any structural abnormalities of the foot such as feet that lean excessively to one side, causing friction between the side of the foot and the shoe, signs of neuropathy and vascular disease, and evidence of any ulcerations and/or infections.

Along with regular foot examinations, a daily footcare routine and proper shoe selection are equally vital to help maintain the health of the feet and protect against foot problems that could lead to amputation. For patients with diabetes, Canadian Certified Pedorthists recommend the following footcare and shoe fitting tips:

Footcare: Pedorthic Pointers for Patients
  • Check your feet daily by visually inspecting them. Be alert for redness, swelling, broken skin, sores or bleeding. See your doctor immediately if any of these problems arise
  • Wear shoes around the home - as well as outdoors - to protect feet from injury
  • Wash your feet with soap and warm water every day, but do not soak them
  • Avoid heat pads or hot water bottles even though your feet might get cold easily. With a lack of sensation it is easy to burn the feet without noticing if the water is too hot
  • Avoid socks with heavy seams, as they can cause irritation of the skin and lead to breakdown or ulceration
  • Avoid tight constrictive socks and clothing that can limit blood flow to the extremities
Shoe Selection: Pedorthic Pointers for Patients
  • Have your shoes fitted properly by a trained specialist such as a Canadian Certified Pedorthist
  • Key features for diabetic footwear include soft uppers with minimal seams, deep and wide toe boxes to reduce abnormal pressure, firm but cushioned soles, removable insoles, a strong heel counter, and a rockered sole
  • Lace up shoes offer a versatile fit and should be used if possible or alternatively use Velcro closures if tying laces is difficult.
  • Avoid slip-on and restrictive footwear such as high heels with pointed toes or shoes that are narrow in style as they depend on a tight fit to stay on the foot
  • When buying new shoes, a good practice is to remove the insole from the shoe and stand on it to see if your foot overlaps the insole, indicating that the shoe is too narrow or short for your foot
  • There should be a full finger width between the end of the longest toe and the end of the shoe
  • Avoid seams over the toe area of your shoes. Seams resist stretching and create bumps that can rub against the skin and cause it to break down or ulcerate
  • If you have a problem with lower limb swelling, graduated compression stockings can help control swelling and improve the fit of shoes over the course of a day
If you are experiencing foot pain or discomfort, you should consult your physician for a proper diagnosis and an appropriate treatment plan. Your doctor may refer you to a Canadian Certified Pedorthist for pedorthic management services including orthopaedic footwear, shoe selection guidance and orthotics.
Reference: Pedorthic Association Canada
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