Author 丨 cause and effect
Source 丨 Medical Circles Endocrine Channel
I secretly tell you that diabetic patients do not wear the right shoes, may …
increase! add! cut! limb! wind! risk!
So it is very important to help diabetic patients choose a pair of suitable shoes! This article analyzes in depth, what kind of shoes are more suitable for diabetic patients!
Diabetic foot (DF) is one of the most serious chronic complications of diabetes. Diabetes foot is mainly manifested as four characteristics: feet peripheral neuropathy, foot biomechanical changes, peripheral vascular lesions, ulcers and other skin infections. The prevalence of domestic diabetic foot is growing year by year with a high -speed growth trend. About 60,000 people are amputated due to foot ulcers or other neuropathy each year.
1. Shoes are the main risk factor that causes foot ulcers
Australia has released the “Guidelines for Diabetes Patients in Shoes in Diabetes” in 2013 and 2018 (referred to as a guide later). The guide clearly stated that foot ulcers related to diabetes are severe complications of diabetes, and it is also a dangerous factor that leads to a clear amputation of lower limbs. A forward -looking study led by the British led in the guidelines proposed that 35%of foot ulcers came to the friction of shoes. In addition, a study from 472 patients from NSW in Australia pointed out that 54%of all patients with foot ulcers clearly came from shoes.
There are many reasons for causing diabetic foot. At present, some studies have stated that inappropriate shoes and socks have caused more than one -third of diabetic patients with foot ulcers, and 85%of diabetic patients have amputation due to foot ulcers. The main causes of shoes and socks caused by the occurrence of diabetic feet are related to stress and the friction of the shoe edge. At present, many studies believe that increased pressure is directly related to ulcers.
The pressure or pain caused by unsuitable shoes is more likely to cause the formation of foot blisters, thick cocoons, and chicken eyes, increasing the risk of foot ulcers and amputation in patients with diabetes. Especially for patients with reduced peripheral nerve sensory function, such patients are more likely to cause foot ulcer due to loss of perception of squeezing and pain.
For patients with severe neuropathy, the ratio of front and rear feet pressure increased significantly. The increased pressure on the forefoot and the imbalance of the underlying pressure are an important factor in the anterior ulcer of the front.
Second, diabetic shoes are an effective way to prevent foot ulcers
For the prevention of foot ulcers in diabetic patients, the guide clearly proposes to wear diabetic shoes that specialize in customized or cooperating with footprints is the key to preventing foot ulcers in diabetic patients. At present, many studies have shown that the use of diabetic shoes can effectively reduce the incidence of diabetic foot ulcers, but wearing time is more than 60%.
People usually think that leather shoes are hard and can cause relatively large pressure on the feet. In fact, the pressure in the leather shoes is lower than the cloth shoes. Although the cloth shoes are soft, the pressure on the heel is greater than the leather shoes due to the heel. It is not conducive to preventing heel ulcers. A domestic study believes that when the heel height exceeds 3.12cm, the loading time began to decrease after the feet. Compared with the strong pressure of the fifth metatarsal bone end in the state of naked feet, as the heel of the shoe increases, the pressure of the fifth metatarsal bone end is significantly reduced significantly. Essence
At present, the design of diabetic shoes and insoles is mainly reflected in the following aspects:
① Reduce the bottom pressure and reduce vibration and cutting force.
② Adapt to the shape and size of the foot, the balance of the tip of the shoe should be 0.95 ～ 1.27cm.
③ There should be plenty of space from the toes to the foot of the feet, which can be adjusted for lace -up shoes, which can adapt to the edema and deformation of diabetic feet.
④ The heels should be comfortable and fit.
⑤ Enhance stability and appropriately restrict the ankle joint.
⑥ Materials with lightweight and strong seismic should be selected.
Third, dangerous people of diabetic foot ulcers
Regarding whether diabetic patients need to wear diabetic shoes to prevent, Australia’s “Diabetes Patients Patients Drives Guide Guide” proposes that shoe recommendations for diabetic patients are mainly based on the dangerous layers of patients’ ulcers.
Low risk level
Outside nerve damage
Periodontal arterial vascular disease
Normal foot shape/history of no amprootic disease
[The ready -made shoes of such patients may be suitable; encourage patients to measure the size of the feet, customize professional shoes; encourage patients to wear shoes that meet the “recommendation of shoe guidelines”. .
Peripheral nerve damage
and / or
Periodontal arterial vascular disease
Normal foot shape/history of no amprootic disease
[The ready -made shoes of such patients may be suitable; encourage patients to measure the size of the feet, customize professional shoes; encourage patients to wear “recommended” shoes for “shoe wearing shoes”; Shoes are guaranteed to adapt to the edema and deformation of the foot in the afternoon. .
Abnormal foot type
History of amputation
[Shoes wearing such patients must be recommended by health professionals who have been trained. .
Fourth, the choice of diabetic shoes
(Refer to Australia 2018 edition “Guidelines for Diabetes Patients Patients in Shoes”)
★ Length: When wearing shoes to stand bearing load, you need to confirm that the shoes have sufficient length. The internal length of the shoe should be 1-2cm longer than the feet length from the heel to the longest toe measurement.
★ depth (depth): It should be adapted to the free movement of the toes without stress on the inside, the outer or back side.
★ Width (Width): Width should equal to the width of all parts of the foot. If the upper is tight, the width is very good. The relationship between the front and the rear feet is important, because the wide front foot may cause the heels to be too wide. ★ Height (Height): The height may be lower than the ankle, flat or higher than the ankle. Advanced shoes provide more firm, more stable and reducing joint movements. High -gang shoes also help to reduce the front foot.
★ Insole: The main function of the insole is the re -distribution of the pressure. This is achieved by increasing the contact area between the foot and the insole and the principle of adding correction elements to the insole. Should use shock absorption, soft but elastic and not slippery materials.
★ Outsole: rubber, plastic and leather can be used to make shoe outsole, but the rubber outsole is considered the best. In addition, the shoes should not be softer than the feet, otherwise the shoes will be friction when launching.
★ Heel Enclosure: It is recommended to use sufficient fit and closed heels, because too wide shoe or heel shells on the back of the foot may cause heels to be injured. Open the state.
★ Heel Lift height (Heel Lift): The heel height (or the heel difference or distance) should generally be 1.5-2 cm and should not exceed 3 cm.
★ Close of the upper: Proper tie laces or nylon buckles keep your feet not sliding forward, and the laces system can ensure long -term tightening and personal adjustment.
★ Upper (Uppers): The upper should be made of leather or synthetic materials (similar to sports shoes). The smooth lining is made of materials that are not hardened with time. There is no seam in the area, the upper should be breathable and durable, and can improve foot malformation without the pressure area.
★ TOE BOX: The part of the shoes covering and protecting the toes should be soft (unless special requirements (such as architectural professionals) have other requirements), and the shape of the toes should be adapted to avoid any friction of the toes.
Five, the status quo
The prevention of diabetic foot has been valued by fellows in China. The guidance for the choice of shoe and socks for diabetic patients is an important part of preventing diabetes.
<!-2586: Diabetic terminal page
At present, many Western countries have studied and designed a variety of diabetic treatment shoes and can be paid in medical insurance. my country’s foot biomechanics is increasingly attracting the interest of clinical workers, and diabetic therapy shoes have just entered the medical market. However, diabetes therapy shoes and insoles are expensive, beautiful appearance, and unsuitable for the hot season to restrict the application of patients. Ordinary cloth shoes lack the protection of heels, and are not suitable for patients’ wearing of patients with increased heel pressure. Therefore, for patients with diabetes with different foot lesions, there should be different textures of shoes and socks, and feet pressure research will provide reliable data.
At present, Chinese diabetic patients and medical workers have not paid attention to the choice of shoes and socks of diabetic patients, and have not fully understood the impact of shoe and socks on diabetic patients. The popularization and education of shoes and socks of diabetic patients still have a long way to go in my country, and domestic guidelines need to be guided.