Blind spots of diabetic foot disease exposed: Wearing the wrong shoes could be the culprit? Experts reveal the "5 keys" to choosing shoes
Facing the increasing number of diabetic patients year by year, how to deal with diabetic foot has become an urgent issue. According to shocking survey data from Tokyo Women’s University in Japan, the top three direct causes of diabetic foot disease are: shoe problems accounting for 69%, burns accounting for 19%, and trauma accounting for 7%. Therefore, for diabetic foot patients, how to correctly determine the degree of their symptoms and how to choose a suitable pair of shoes will become the most important and urgent matters to pay attention to.
Complete debridement surgery eliminates the risk of amputation! Three key points in caring for diabetic foot patients
When diabetic foot patients inevitably have wounds or even ulcer symptoms, the main treatment method is “debridement” to remove necrotic and infected tissue. If the wound infection is severe and the soft tissue is damaged, amputation may be necessary. I often say to patients: “Dead people cannot be resurrected, and the same goes for tissue necrosis.” Thorough debridement is the most basic, because if the necrotic tissue is not removed at once, the necrotic tissue will become a breeding ground for bacteria and it is easy to expand infection. to otherwise healthy tissue.
Therefore, in addition to thorough debridement surgery, we must also consider how to close the wound and how to wear shoes and prosthetics afterwards. Unfortunately, health insurance adopts a price-based system, so many diabetic patients are reduced to cows kept in pens by some doctors, who are taken out and milked regularly. For example, if the cows are not completely removed during debridement surgery, they will be treated today and put back. The cattle pen will be taken care of tomorrow, and even the amputation will be the same. Simply because the more surgeries are performed, the more health insurance benefits you can receive.
In addition, Taiwan’s medical referral system is not perfect, so some doctors still have the mentality of “how can they milk the cows they raise for others?” Physicians will not refer to surgeons, and surgeons will not refer. For foot and ankle orthopedic surgeons, sometimes blood vessels are blocked and the help of cardiovascular surgery is needed before the wound can be cured. Overall, diabetes should be a team disease, requiring multi-disciplinary consultation and division of labor so that patients can receive more complete diagnosis and treatment. In such a general environment, patients must build up enough knowledge on their own to be able to judge and find the right branch of the disease on their own, so as not to become the cows raised by some doctors and live in the cow pen for a long, long time.
For level 3 and above, you need to wear customized shoes! Physicians reveal guide to grading diabetic foot
The following provides a guide to grading diabetic foot, professional shoe selection and medical monitoring, which can jointly maintain foot health!
Level 0: No neuropathy occurs. Patients can still wear regular shoes, but it is best to have routine checkups every year. At this stage, there is no need to resort to foot and ankle specialist diagnosis and treatment.
Level 1: A small needle is used to prick the patient’s skin about 0.5 centimeters apart. If the patient cannot tell the difference and thinks the needle is pricking the same part of the skin, this means that the patient has some slight neuropathy. At this time, patients are absolutely prohibited from wearing high heels and can only wear sports shoes and casual shoes. At this stage, it is best to seek proactive guidance from a foot and ankle surgery specialist and conduct a check-up every six months.
Level 2: Previous amputation of a toe or ulceration (non-plantar ulcer). Patients at this stage must wear diabetic foot shoes and be checked every four months.
Level 3: There has been a big hole in the wound, or more than two limbs have been amputated, and the shape of the foot has been deformed. Patients entering this stage must wear custom-made shoes and consider seeing an orthopedic foot and ankle subspecialist for assistance. In addition, regular inspections must be carried out every two months.
Wearing the wrong shoes could be the culprit for the worsening of diabetic foot? Experts reveal the “5 keys” to choosing shoes
Although patients whose neuropathy is still at level zero or level one do not need to wear special diabetic shoes, they should try to comply with the spirit of diabetic shoes when choosing shoes.
The “toe box” (the place where the toes are placed) on the front of the shoe must be wide and deep enough to allow the toes to move slightly inside. Many people have claw toes, which are prone to ulcers caused by rubbing shoes on the backs of the toes.
The soles should be soft enough, but also supportive enough to prevent the midfoot from becoming more deformed. If it has been deformed, you may want to consider custom-made insoles.
The middle part of the body should have shoelaces or buckles that can be adjusted for tightness. They should not be too loose and slip, nor should they be too tight and affect blood circulation.
The part that covers the heel must be strong enough to prevent the heel from swinging inside, causing more friction.
Shoes should be light enough to reduce the impact of muscle weakness and contracture on diabetics.
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