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The Techniques and Analysis of Comprehensive Shoe Fitting For Diabetic Patients
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Excerpts from: The Techniques and Analysis of Comprehensive Shoe Fitting For Diabetic Patients
By Jerry Lockard, President of the National Association of Certified Diabetic Footwear Specialists
A Diabetic Patient should always wear socks or hosiery of some type to protect their feet and prevent shear (friction) between the layers of skin on the foot. In that the sock is the primary interface in direct contact with the foot, it is a quandary as to why the issue of Diabetic Hosiery has remained largely overlooked in the treatment and prevention of Diabetic Foot conditions.
Foot ulcers and amputations are a major cause of morbidity, disability, and costs for people with diabetes. It is documented that education and proper preventative foot care reduce the incidence of foot ulceration in the diabetic population. Primary risk factors that lead to the development of foot ulcers on diabetic feet are pressure focal points, poor moisture management, and blister causing shear. Appropriate sock selection can help manage these risks by helping to maintain proper shoe fit, manage moisture levels and provide needed foot protection. Many patients do not realize that the inside lining of most shoes wear fairly quickly and can subject at-risk feet to abrasive hazards such as eyelets, rivets, seams, buckles etc., that may damage the Diabetic Foot.
The Diabetic Patient often does not feel these conditions develop because of neuropathy, which decreases their ability to feel an abnormal condition such as those described above. Poor circulation, also a diabetic symptom, decreases the foot.s ability to heal satisfactorily. These conditions, typically minor irritations for healthy, non-diabetic feet, can escalate out of control into major health issues for the Diabetic. Properly made socks provide protection from many hazards, enhance the benefits of a well-made shoe, and can alert the wearer to possible foot problems.
The medical sock and hosiery industry has recognized that Diabetic Patients have special sock and hosiery needs that must be addressed. Through their research, specific medical designs have been developed to enhance protection for the Diabetic Foot.
Key features unique and critical to socks for Diabetics are as follows:
Focal Pressure: Diabetic socks should be truly seamless. Seams, present in standard socks, present pressure points that could lead to the development of ulcers. Researchers at the University of Texas Health Science Center in San Antonio studied the evidence that supported the anecdotal clinical evidence that sock seams introduced localized high pressure points and concluded that .manufacturers could be encouraged to continue the production of seamless socks. which they found could reduce pressure by 60%.
Anatomical Fit: Perfect conformity of the sock to the natural anatomical shape of a foot is critical to provide a smooth, wrinkle free fit that eliminates unnecessary pressure points caused by looseness or bunching. Socks constructed of all directional stretch (corespun) yarns yield the best results.
Friction and Shear: A smooth, non-bulky fit functions as an interface preventing friction between the skin and the shoes.
Dry Skin: Fibers such as CoolMax four-channel polyester and other wicking acrylic fibers transport moisture away from the skin to the surface of the sock where it can evaporate or be absorbed by the shoe bed to keep the skin.s surface dry and prevent sores. These fibers have also been proven to be less compacting (i.e. protect better against shear) than the cotton fibers traditionally recommended. It is worth noting that these fibers will not absorb moisturizing skin treatments.
Circulatory Insufficiency: Corespun stretch yarns must be calibrated to exert low compression so that the form fitting, seamless socks will fit without restricting circulation. Socks with limited stretch can be harmful . especially as feet typically swell during a day.s wear.
Infection: Proper diabetic socks will have permanent antibacterial inhibitors, (permanent being the life of the sock, or a minimum of 50 wearings and washings). Wearing white socks gives the advantage of being able to easily detect any discharge that might occur. The availability of properly constructed socks in fashion colors will likely increase patient compliance.
Edema (or Obesity): Low compression yarns with 4-way stretch allow the stretch needed for patients with swelling or excess weight. Having the ankle calf portion knitted with a looser stitch gives even greater stretch in that critical area.
Diligence in purchasing proper socks that help to minimize the risks associated with pressure points, poor moisture management, and blister causing shear is a logical preventative effort in assuring good foot health.
Fiber Controversy
Herring and Richie established two landmark studies in the Journal of American Podiatric Medical Association, documenting the superiority of acrylic over cotton fibers in preventing friction blisters in running athletes (1,2). These studies verified previous laboratory studies that had demonstrated the technical superiority of acrylic over cotton. These findings were proven reproducible over a series of 1,000 run-trials performed by the human subjects.
Conclusion:
Previous laboratory studies were now verified by clinical investigation demonstrating that, compared to synthetic high-tech fibers such as acrylic and
Cool Max®, cotton fiber socks will:
Compress significantly when subjected to moisture.
Resist wicking of moisture effectively away from the skin while synthetic high-tech fiber socks encourage wicking or moisture movement away from skin surface to shoe upper.
Lose their resiliency and protective benefit compared to synthetic high-tech fiber socks, particularly when wet.
Lose their shape allowing the sock to bunch and wrinkle compared to synthetic high-tech fiber socks.
BIBLIOGRAPHY
Herring KH, Richie DH: Friction blisters and sock fiber composition: a double blind study. Journal of the American Podiatric Medical Association 80:63, 1990.
Herring KH, Richie DH: Comparison of cotton and acrylic socks using a generic cushion sole design for runners. Journal of the American Podiatric Medical Association 83:9, 1993.
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