Appropriate footwear

Inappropriate footwear is a major cause of ulceration. Appropriate footwear (adapted to the altered biomechanics and deformities) is essential for prevention. Patients without loss of protective sensation can select off-the-shelf footwear by themselves. In patients with neuropathy and/or ischemia extra care must be taken with the fitting, particularly when foot deformities are also present. The shoe should not be too tight or too loose (see figure 4). The inside of the shoe should be 1-2 centimeters longer than the foot itself. The internal width should be equal to the width of the foot at the site of the metatarsal phalangeal joints and the height should allow enough room for the toes. The fitting must be evaluated with the patient in standing position, preferably at the end of the day. If the fitting is too tight due to deformities or if there are signs of abnormal loading of the foot (e.g. hyperemia, callus, ulceration) patients should be referred for special footwear (advice and/or construction), including insoles and orthoses.

Fig 4. The internal width of the shoe should be equal to the width of the foot.