Two weeks ago, a patient came in to the pharmacy complaining that his feet were burning and sore, and he was developing blisters on the top of his left foot. The patient had diabetes for about 13 years and had recently been running an A1c of 7.9. He was also about 55 lbs. overweight and even though he claimed that he had been trying to lose weight, he had not been successful.
Our first thought was that his skin was dry and that he had worsening neuropathy. We wanted to refer him back to the prescriber for medication therapy. However, as he was sitting in the chair waiting for his prescription, our technician commented on his new shoes. When I questioned him, he told me that his local shoe store had just gotten him some new “diabetic shoes” as his insurance would cover a new pair.
I asked how they had made the shoes and he told me that he had stepped in a foam mold to shape the foot bed correctly and then they tried on sample pairs to see what felt right to him, and he noted that he was now wearing a size 9.5 rather than the 10 he was wearing previously.
I advised him to put the old shoes back on and see what happens. In 10 days, the blisters, burning and soreness had disappeared.
- Oftentimes, as diabetes advances, we lose feeling in all parts of our feet, so older shoes will feel looser. This means that the patient will often buy a smaller shoe to regain the same secure feeling.
- Shoe molds allow us to get an accurate shape of the bottom and lower sides of the foot, but do not help in determining how deep the shoe needs to be.
- Shoe fittings should include measurements of upper foot size as well as lace or closer placement.