Wearing the right shoes is of utmost importance to diabetes sufferers. Poorly fitted shoes are the culprit for half of the foot problems that lead to amputations, according to the American Podiatric Medical Association.

If the shoe fits

Since foot size and shape can change over time, each time you go to buy shoes find an experienced shoe fitter to measure you. Remember, new shoes should be comfortable right away, a "break-in" period should not be necessary. Footwear should be long enough, wide enough, and deep enough to wear without rubbing or constricting any part of your feet.

Sturdy, cushioned shoes with leather or canvas uppers are recommended. They should be comfortable enough to let the toes wiggle, but not loose enough to cause the foot to slide and rub along the sides. If you have good circulation in your feet and no foot deformities, off-the-shelf shoes made for people with diabetes can work well, even if you have some nerve damage.

If the blood flow in your feet is poor, your doctor or podiatrist will most likely suggest custom-made footwear. Those with insensate feet (lacking sensation) are at a 60% risk for developing a foot ulcer within the next 3 years. Custom footwear can decrease this risk to 20% over the 3-year period.

For custom footwear, a podiatrist or orthopedist will provide the initial evaluation and prescription. A pedorthist then fills the prescription and fits you for your shoes. An orthotist can make any orthotic device that fits in your shoes, as prescribed by your podiatrist or orthopedist.

Tips for buying shoes:

• Shop for shoes in the afternoon. Your feet tend to swell during the day, and it's best to buy shoes when your feet are their normal size.
• Have your feet measured every time you purchase shoes.
• Have your feet measured while you're standing.
• Try shoes on both feet. Many people have one foot larger than the other. It's best to fit the larger one.
• Stay away from shoes with pointy toes or high heals as they cause added pressure to shift to your toes. If you must wear them, do so infrequently and for short periods of time.
• Never wear vinyl or plastic shoes, because they don't stretch or allow your foot to get air.
• Recognize the signs of ill-fitting shoes. For example, corns and calluses are caused by friction from skin rubbing against bony areas of the feet, usually caused by shoes that don't fit properly.
• It's best to have more than one pair of shoes, and alternate wearing them to avoid rapid deterioration of the shoes.
• The condition of the shoe is more important than the price tag or brand name.
• Excessive wearing of the outer sole, loss of shoe counter support, or wearing out in the midsole indicate it's time to replace the shoe.

Keep your feet safe from harm

Avoiding injury and keeping your feet covered, warm and dry is the best game plan for people with diabetes. To protect your feet follow these guidelines:

• Keep feet covered with shoes and/or socks at all times, don't go barefoot, even when indoors.
  
• Always wear socks or stockings with shoes to help avoid blisters and sores.
  
• Sleep with socks on if your feet get cold at night.
  
• Make sure socks are thick and soft, an acrylic/cotton blend works well to reduce sweating. Avoid socks that have been mended, have holes, or ones or with big seams. The small bumps in the cloth can rub against your skin and cause blisters or other skin irritations and injuries.
  
• Wear shoes at the beach and on hot surfaces.
  
• If exposed to the sun, use sunscreen on your feet to prevent sunburn
  
• Don't use a hot water bottle or heating pad on your feet.
  
• Don't test bath water with your feet.
  
• In the winter, wear boots with a lining to keep your feet warm and dry