A Step Ahead: Does the shoe fit? It needs to, especially if diabetic.

by Ralph J. Napolitano, Jr., DPM, CWSP, FACFAS

winter walkHappy New Year! With the ball drop now a thing of the past, “resolutions” should be in place by now. What’s it going to be for you? Travel more? Lose weight? Climb Mount Everest? According to Statista, an organization that compiles statistics from more than 18,000 sources, 53 percent of respondents said their resolution for 2018 is to save money, while 45 percent would like to lose weight or get in shape. If you’ve jumped on the lose weight plus get in shape band wagon, healthy feet are definitely part of the equation. And good quality, properly fitting shoes are obviously needed to keep your feet healthy. Unless you have the luxury to be unshod on a tropical island, your footwear is one with you. Poorly fitting shoes equal misery. Get this: The average person takes enough steps in their lifetime time to walk the earth four times. Eyeball that pedometer and see for yourself how many steps you take in a day, a week, a month and a year.

On to our shoe fit discussion. We touched on this a few months back in my Choosing Athletic Shoes blog article. When evaluating correct shoe fit, know your foot type and get measured periodically.

  • Arch shape (high or low) and foot function (pronating and supinating actions in walking and running) are important to know since certain shoes obviously fit differently.
  • Shoe shape is dictated by the shoe “Last.” A shoe Last is a 3-dimensional wooden or plastic mold upon which a shoe is constructed. The Last used during shoe assembly can affect the overall fit of a shoe, and all Lasts include the following dimensions: Heel width, instep height and forefoot width. Some Lasts are wider and rounder whereas others are more square and so on. It’s a myth that foot size doesn’t change in adults. As we age, feet change which may result in a shoe size change. Moms: you may have experienced this post-partem.
  • Certainly foot deformities, such as bunions and hammertoes, are a huge consideration and need to be “accommodated” by shoe gear.

With respect to measuring, the longest toe is the benchmark and is usually the first or second toe (heel-to-toe measurement). There is also arch length which is a foot measurement from the back of the heel to the center of the first metatarsal (Heel-to-Ball in shoe store speak). Shoes are designed to flex at the ball of the foot. Correct fitting properly positions the first metatarsal “ball joint” in the shoe and provides room for the toes so they are not confined. Compare the arch length to the heel-to-toe length. In general, you’ll use the larger of the two measurements as the correct shoe size. If the arch length and heel-to-toe length are the same, this will be the shoe size. If the heel-to-toe length is larger than the arch length, then fit to the heel-to-toe size. If arch length is larger than heel-to-toe, then fit to arch length. Don’t forget foot width. This is certainly important and mandatory to know when shoe shopping. Finally, be sure to consider all these measurements for BOTH feet. Be sure to have both feet measured and fit the larger foot. It is not uncommon to have feet of different sizes.
There are nearly endless makes, models and styles of shoes on the market. Even though size is chosen correctly and foot type is accounted for, the shoe you’re trying on may not feel quite right. Variation among “identical” pairs is a reality since shoes are mass produced (Custom made shoes is another topic). Select another pair to try on, same make and model, or start over looking at something different. A general rule of thumb is the “rule of thumb.” Make sure you have about a full thumb’s nail length from your big toe (or second toe if it’s longer) to the end of the shoe. Don’t be afraid to go up a half a size (or even a full size) depending on the shoe. This is especially important to keep in mind for athletic shoes. Running (and to a lesser extent walking) causes our feet to swell so you’ll want to have plenty of room in the toe box. Strongly consider shopping for shoes later in the day when your feet are more expanded. Shoes don’t “stretch” on their own with wear although the materials will soften with initial wear after a day or so (Note: some shoes can be stretched by a qualified cobbler which is also another topic). If they don’t feel right at the time of purchase they probably will never feel right. Remember to do a good “test” walk (or jog if athletic shoe shopping) before your final decision.

If you have diabetes, you hopefully know how important it is to have good quality, proper fitting footwear. Improperly fitting shoes can cause huge problems in the diabetic patient. One very common variation of lower extremity nerve damage in diabetic patients is loss of protective sensation. The general term for this is “diabetic neuropathy.” If a shoe is rubbing a foot part “raw” per se, the patient may not feel this frictional injury. This also holds true for patients that have sensation loss (neuropathy) and DO NOT have diabetes. What results is a foot wound known as a “neurotrophic ulcer.” Such injuries can be very challenging to heal and are limb, and life, threatening. The best way to prevent such foot wounds is good quality, proper fitting shoes. At OrthoNeuro, we are pleased to announce that we now offer footwear designed for diabetic and neuropathic patients. If you are diabetic, Medicare covers diabetic shoes and insoles and many other commercial insurance plans do as well. Yes, they look very nice and you wouldn’t know that they are “medical” grade footwear on the outside. However, the inside of the footwear has all those necessary components to help protect your feet if you have sensation loss. These include seamless construction and replaceable, protective insole sets. Typically, insurance covers one pair of diabetic shoes and three pairs of insole sets per calendar year.

Welcome 2018! Put your shoes on, get out there, and make it a good one!

Dr NapolitanoDr. Ralph J. Napolitano, Jr.
Board Certified Podiatrist and Wound Care Specialist
“Your foundation for healthy feet.”

Dr. Napolitano is a double board-certified podiatrist and wound care specialist physician. (CWSP). He specializes in medicine, surgery and wound care of the foot, ankle and lower leg. He was the first podiatrist in the state of Ohio to earn the board certification Certified Wound Specialist Physician (CWSP). Areas of special clinical interest and research include: general podiatric medicine and surgery, wound care and healing, diabetic limb preservation and surgical limb salvage, digital joint replacement and preservation surgery in the foot, lower extremity dermatology and infectious diseases, custom foot orthotics, gait analysis and athletic shoe gear consulting, aesthetic podiatry and laser care.

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