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Diabetes is a complicated disease that implicates the whole body and that could lead to severe complications if left untreated. As it is becoming more prevalent amongst Canadians, it is important to be educated on the subject, which will help prevent progression of any of its possible complications. The estimated Canadian pre-diabetes prevalence (age 20+) and diabetes prevalence are of 5.7 million and 3.4 million, respectively. These numbers are expected to rise to 5 million and 6.4 million as indicated by Diabetes Canada [1]. Diabetes can lead to reduced sensation and poor circulation in the lower limbs. When no care is devoted to theses consequences, further complications may present themselves, such as wounds and foot ulcers. Because the healing process is compromised by the disease, its influence on the wounds and foot ulcers could lead to worse outcomes, such as amputations. Foot ulceration affects an estimated 15-25% of people with diabetes. One-third of amputations in 2011-2012 were performed on people reporting a diabetic foot wound [1]. As stated by the Pedorthic Association of Canada, the Canadian Diabetes Association recommends that all individuals who have diabetes have their feet examined by a doctor as well as get screened for neuropathy and circulatory deficiencies every year. There are many other Healthy Steps a person living with diabetes can take to help ensure proper foot health:

Footcare [2]
• Visually inspect your feet daily. Be alert for redness, swelling, broken skin, sores or bleeding. See your doctor immediately if any of these problems arise
• To protect your feet from injury, wear your shoes indoors and outdoors
• Wash your feet with soap and warm water every day, but do not soak them
• Avoid heat pads or hot water bottles even though your feet might get cold easily. With a lack of sensation it is easy to burn your feet if the water is too hot
• Avoid socks with heavy seams as they can irritate the skin which can lead to breakdown or ulceration
• Avoid tight constrictive socks and clothing that can limit blood flow

Shoe Selection [2]
• Have your shoes professionally fitted by a trained specialist such as a Canadian Certified Pedorthist
• Select footwear with the following features: soft upper with minimal seams; deep, wide toe boxes; firm but cushioned soles; removable insoles; strong heel counters; and rockered soles
• Lace up shoes offer a versatile fit and should be used if possible. However, if tying laces is difficult select footwear with Velcro closures
• Avoid slip-on and restrictive footwear such as high heels with pointed toes or shoes that are narrow in style as they depend on a tight fit to stay on the foot
• When purchasing shoes, remove the insole and stand on it. If your foot overlaps any area, the shoe is too narrow or too short for your foot
• Make sure there is a full finger width between the end of your longest toe and the end of your shoe
• Avoid seams over the toe area of your shoes as seams resist stretching and create bumps that can rub against your skin and cause it to break down or ulcerate
• If you have a problem with lower limb swelling, talk to your Pedorthist about graduated compression stockings to help control the swelling and improve the fit of your shoes over the course of a day

How can Pedorthists help? Off-the-shelf or custom foot orthoses, specialty or custom footwear, footwear modifications to aid in pressure unloading or to improve mobility, various “pressure unloading” devices to help with wound healing, speciality diabetic socks, and compression hosiery.


[2] Pedorthic Association of Canada – Diabetic Foot Care

With the online shopping trend becoming more common and the loss of some valuable footwear stores, it’s important for a person living with diabetes to get fitted properly with footwear before the purchase.