Diabetics May Not Need Special Shoes

Medicare pays for therapeutic footwear for thousands of people with diabetes each year, but some researchers say that the footwear may not be necessary.

University of Washington researchers found that for many diabetes patients, regular good-quality shoes may work just as well in preventing foot ulcers. Their results are published in Wednesday's issue of the Journal of the American Medical Association.

"The results were surprising," said lead researcher Gayle Reiber of the Veterans Affairs Puget Sound Health Care System.

"The popular notion among foot specialists is that therapeutic shoes and inserts should be prescribed freely to all patients with diabetes and prior foot ulcers," Reiber said. "However, this study did not provide evidence to support this practice."

An estimated 17 million Americans have diabetes. Footwear is a concern for those with diabetes because the condition may cause peripheral nerve damage and poor blood circulation, leaving patients with little to no feeling in their feet. As a result, pressure from shoes and minor trauma are more likely to lead to ulcers.

Reiber said that careful attention by doctors may be more important than therapeutic footwear in preventing ulcers. But patients not receiving this level of care may in fact benefit from special footwear, she said.

Researchers studied 400 men and women with diabetes and a prior foot ulcer. They found that ulcer rates were similarly low in groups that wore theraputic shoes and groups that wore their own shoes.

The study did not include those 5 percent of diabetic patients with severe foot deformities or other special problems who may benefit from custom-made footwear.

Researchers said the low rates of foot ulcers found in the study's participants could also be due to the specially designed slippers they wore when not in their shoes. All participants also had access to good-quality health care. Reiber said that the extra attention given the study participants may have contributed to the overall low rate of ulcers in all three groups, regardless of what kind of shoes they wore.

Half of U.S. adults with diabetes have one or more foot-risk conditions and 10 percent of these adults report a prior foot ulcer.

These ulcers can become severe enough to require amputation. People with diabetes account for more than 90,000 of the roughly 134,000 lower-limb amputations performed annually in the United States. About half these diabetes-related amputations are attributed to poorly fitting footwear.

Foot care specialists routinely recommend that patients with diabetes and foot risk factors buy special "depth" shoes with extra room in the toes. Since Medicare adopted the Therapeutic Shoe Bill in 1993, the cost of these shoes, along with inserts -- up to $318 per year -- is covered for certain patients who do not have severe foot deformities.