Management of Patients with Foot Complaints

Assessment and Footwear Recommendations

The Centurion guidelines indicate that patients without documented foot pathology do not qualify for medical shoes 1, 3
Patients without loss of protective sensation or foot deformities can select properly fitting off-the-shelf footwear independently, according to the Diabetes/Metabolism Research and Reviews 4
The American Diabetes Association recommends that the inside of the shoe should be 1-2 cm longer than the foot itself, and the internal width should equal the width of the foot at the metatarsal phalangeal joints 3, 5
Athletic shoes with proper cushioning that redistribute pressure are appropriate for patients without significant foot pathology, as recommended by the American Diabetes Association 6
Evaluate shoe fit with the patient in standing position, preferably at the end of the day, as suggested by the Diabetes/Metabolism Research and Reviews 3, 5

The American Diabetes Association advises against barefoot walking indoors or outdoors, and recommends against wearing shoes without socks 4
Patients should inspect and palpate the inside of shoes daily, and change socks daily, as recommended by the Diabetes/Metabolism Research and Reviews 4
Educate patients on regular washing of feet with careful drying, and proper use of lubricating oils or creams for dry skin, as suggested by the Diabetes/Metabolism Research and Reviews 4

If the patient continues to report foot pain despite proper footwear, reassess for any pre-ulcerative signs or excess callus that may require treatment, as recommended by the Diabetes/Metabolism Research and Reviews 7
Consider if foot deformities are present that might need non-surgical treatment, such as with an orthosis, as suggested by the Diabetes/Metabolism Research and Reviews 3
Evaluate for neurologic causes of heel pain if symptoms persist, as recommended by the American Family Physician 2