subject: Selecting Shoe Inserts For Diabetics [print this page] Diabetic feet require extra protection under the foot to protect the skin from damage due to pressure and shearing forces inside the shoe. While multiple types of shoe inserts are available for use in all types of situations, only certain inserts will be of benefit to diabetic feet to protect the skin from injury. This article will discuss which inserts are not useful for diabetics, and which inserts will provide that needed protection.
There is often a public point of confusion between diabetic shoe inserts and orthotics, store-bought arch supports, and simple gel or foam shoe padding. All of them fit inside shoes, and are designed to help the foot in someway. However, there are big differences between these inserts, not only in design and materials but also in function and purpose. This difference is vitally important when it comes to diabetic foot support. We'll start with the two most basic of inserts, and the types most people are familiar with. The shoe pad is simply a thin layer of foam or gel meant to replace the sock liner of a shoe with something more cushioned. The inserts, often advertised on TV with people 'gellin', are inexpensive pads meant to simply increase the perception of comfort within the shoe. They offer little to no support, and simply make the shoe feel more cushioned. In all practicality, these give diabetics no real benefit.
Store-bought arch supports are a little different. There is a wide variety of inserts found in pharmacies and arch support stores, and with this variety comes different levels of foot support. The range can run from flimsy arch pads and flexible foam, gel, or plastic supports to expensive hard plastic inserts sold in arch support chains. All of these are sized based on shoe size without any consideration for the actual differences in shape and function for an individual's own feet. Despite attempts to market otherwise, the expensive arch support store inserts and the pharmacy inserts chosen after stepping on a 'foot scanner' are simply the same general product as a pharmacy shelf insert, only with a little more support and a much higher price tag. These inserts as a whole do have a role to play in foot care. People who need limited arch support, or need extra cushioning for shock absorption if their arches are high will benefit from these inserts. They provide a greater level of support than shoe pad inserts, and for those without specific support needs due to significant foot pain or deformity they will be sufficient. However, they still provide little benefit to diabetics, as their support will not reduce foot pressure enough to protect against skin wounds and abnormal pressure points.
The last two categories of inserts are notably different than the preceding inserts. Both prescription orthotics and diabetic inserts provide high level support and protection for diabetic feet, in ways store-bought inserts cannot provide. Diabetic inserts are used to reduce pressure and shearing to fragile areas of a diabetic's feet by surrounding the bottom of the foot with a special deforming foam called plastizote. This advanced material has heat-molding properties that allows for a matching of the foot contours by either being pre-heated and stepped on to provide an initial foot molding, or by the continuous presence of body heat when worn which will shape the insert like the foot. Diabetics with neuropathy (of which many diabetics suffer), diabetics with prominent bones, and diabetics with calluses or a history of foot wounds benefit greatly from these highly specialized inserts. Traditionally, these inserts contain one to three layers of plastizote, with each layer having different density. Other materials forming a layer where the insert meets the shoe can be used to provide stability to the insert. Single layer plastizote inserts without a support layer are made, but these are insufficient for practical use, and are not approved by Medicare. Some diabetics benefit more from plastizote inserts that are custom made from a cast of the foot. The presence of severe deformity, amputations, or high risk of wound development makes customized plastizote inserts (as opposed to the prefabricated kind) more necessary. With the use of either kind of diabetic insert, the likelihood of wound development on the bottom of the foot is significantly reduced. However, foot deformity or structural bone abnormalities that cause increased pressure to the foot may not be supported by a diabetic insert, and diabetic inserts cannot alter or support the structure of the foot, as they just accommodate for the foot shape as it exists. This is true of even the custom plastizote insert.
Prescription orthotics, on the other hand, will actually alter foot structure, especially when that structure is deformed because of flat feet. These thermoplastic inserts are made by taking a plaster impression of the foot, while holding the foot in a corrected position. Not only do the inserts that are made from this impression match the individual foot contours exactly, they also match the foot as it should normally be positioned without excessive rotation. The foot is therefore stabilized in this position, and any abnormal pressure due to abnormal foot structure is significantly reduced. Instead of the material being soft and compressible like plastizote, prescription orthotics are made from a hard plastic that conforms to the shape of the foot mold through a heating process. By using this type of material, the weight of the body is resisted and the insert will retain its stiffness, and therefore it's ability to alter the foot structure. Comfort is maintained despite its hardness because the insert is an exact match to the individual foot. Plastizote coverings are added to the inserts to reduce pressure and friction even further. They are commonly used in many individuals with and without diabetes to support excessive foot flattening, reduce arch ligament injury (plantar fasciitis), and treat serious foot tendonitis and spraining. Orthotics also have a dual role in reducing the structural cause of foot wounds, especially under the ball of the foot. For diabetics with significant foot structural abnormalities, prescription orthotics are the preferred way of protecting the foot.
As one can see, there are a plethora of options available to provide better support of the foot. Diabetics, because of their unique needs, should choose wisely as only certain inserts will truly benefit the diabetic foot and protect it from harm.
