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[IP] If the Shoe Fits, Diabetics Can Wear It

Note that this study does NOT say anything about charcot foot (a horrible 
complication of diabetes that no one should have to suffer with (if anyone 
needs info, I'm CURED or at least temporarily CURED of it))

Custom inserts and shoes are not needed in those with good routine foot 
care. MedscapeWire  2002 
<a href="http://www.medscape.com/viewarticle/433538?srcmp=endo-051702">
Read it Here</a>

If the Shoe Fits, Diabetics Can Wear It

Laurie Barclay, MD

NEW YORK (MedscapeWire) May 15  Good-quality, properly fitting shoes may 
prevent diabetic foot ulcers just as well as custom therapeutic inserts and 
footwear, according to results of a randomized trial published in the May 15 
issue of The Journal of the American Medical Association. Still, healthcare 
professionals should devote careful attention to routine foot care in 
"The results were surprising," lead author Gayle E. Reiber, MPH, PhD, of the 
Veterans Affairs (VA) Puget Sound Health Care System and the University of 
Washington, says in a news release. "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. However, this 
study did not provide evidence to support this practice."

In this study, researchers randomized 400 men and women with a history of 
diabetic foot ulcer to wear extra-depth therapeutic shoes with customized 
cork inserts, therapeutic shoes with noncustom polyurethane inserts, or 
their own shoes. Patients with severe foot deformities or other special 
problems who might benefit from custom-made footwear were excluded. All 
subjects wore specially designed slippers when not in their shoes, and all 
had access to good-quality healthcare, including visits every 17 weeks with 
a team that included a foot-care specialist.

After 2 years, ulcer rates were low in all 3 groups: 15% for those with 
customized inserts, 14% for those with standard inserts, and 17% for those 
who wore their own shoes. These rates were dramatically lower than those in 
earlier European studies.

According to Reiber, the extra attention given these subjects may have 
contributed to the overall low rate of ulcers in all 3 groups. Although 
careful attention by healthcare professionals may be more important than 
therapeutic footwear in preventing ulcers, patients with limited access to 
care may benefit from special footwear.

For diabetics, foot-care specialists routinely recommend "depth" shoes 
providing extra toe room, along with inserts, which are reimbursable by 
Medicare up to $318 per year. "The evidence suggests that a shift in the 
diabetic foot-care paradigm may be in order," says researcher Douglas C. 
Smith, MD, of the University of Washington.

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