Even a custom molded shoe may still cause problems….
A patient of mine who had diabetes and peripheral neuropathy came home from the hospital after a below-the-knee amputation of her right leg.
She lived alone and was housebound. Having lost one leg, I knew she was at increased risk for losing her other leg.
While in rehab, she had a professionally custom molded shoe made for her left foot which she started to wear. When I provided a diabetes foot exam on her left foot, I noticed redness from her custom molded shoe which seemed to be rubbing against her left foot. Her vision was poor, and she had no sensation, so she was not aware of it. I recommended she stop wearing that shoe. I then proceeded to contact the orthotics and prosthetics health care company from where she purchased her shoe demanding a home visit to assess the fit of her shoe and make the necessary adjustments.
Both she and the company argued with me at first. “How could a custom molded shoe not fit?” My answer was, “I don’t know, but it doesn’t. I don’t want to see her lose another foot and/or leg.” A home visit was made and sure enough, the shoe didn’t fit right. The company tried to make adjustments, but even those adjustments didn’t work. In the end they made her a new shoe that fit. Perhaps another amputation was prevented.
Know what a diabetes foot exam consists of. Always check your patients’ feet. They may be seeing another health care professional, or may have professionally-made shoes, but take the responsibility, check yourself and speak up for your patients.
Joy Pape, MSN, RN, FNP-C, CDE, WOCN, CFCN, FAADE
Certified Foot Care Nurse
Associate Medical Editor, Diabetes In Control
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