Choosing shoes when you cannot feel your feet

Why comfort is a misleading test

Ordinarily you would reject a shoe because it hurt. With reduced sensation, the shoe that is causing damage often feels like nothing at all — and, worse, a tight shoe can feel reassuringly secure. Many people with neuropathy describe consistently buying shoes a size too small because loose feels unsafe.

So replace the comfort test with two objective ones: measure the foot, and inspect the skin after wear. Those two together are more reliable than any amount of feel.

Measure, do not estimate

Measure length and girth at the end of the day, standing, both feet, and buy for the larger one. Re-measure yearly — neuropathic feet change shape over time, and people are frequently still buying the size they wore twenty years ago. The home measuring guide has a printable gauge.

A common and useful check: stand on a piece of paper, draw round the foot, then stand the shoe on the drawing. If the outline disappears under the shoe anywhere, the shoe is narrower than your foot. That is the shoe forcing your foot into a shape it is not.

What the shoe itself must have

No seams across the forefoot lining or over the toes. A toe box deep enough that clawed toes are not pressed from above. An opening wide enough that the foot is lowered in rather than scraped in. A removable insole if you wear a device. A strap rather than laces if hands or eyesight make precise adjustment hard. A closed toe and a firm heel. And a smooth, snag-free lining you can run a hand over.

In this range that means DW-006 Twin-Strap Wide Fit Trainer for a straightforward neuropathic foot, DW-015 Extra Wide Wrap Trainer if the forefoot has spread or a device is going in, and DW-019 Full-Wrap Extra Wide Trainer if there is swelling, a dressing or a foot that changes volume through the day. DW-013 Mesh Wide Fit Trainer is the one to choose if heat and moisture are damaging the skin, because the open-mesh forefoot panel moves air over exactly the area that macerates.

Breaking in a new pair safely

One hour on day one. Take them off, inspect both feet including between the toes. Any redness that fades in a few minutes is fine. Any mark still there after twenty minutes is a fitting failure — stop, and change the shoe rather than persevering. Usually that means a style that opens wider, not a longer size. If day one is clear, two hours on day two, then build gradually across a fortnight. Never wear new shoes for a long day out, a holiday or a wedding first.

The daily routine

Look at your feet every day in good light, using a mirror or a phone camera for the soles. Check between every toe. Run a hand inside each shoe before putting it on, feeling for grit, a rucked insole, or anything working through the lining. Change socks daily and choose seam-free ones. Never walk barefoot, indoors included.

When to get help the same day

Any break in the skin, however small. New redness, heat or swelling in one foot. Any discharge, smell or discolouration. A foot that suddenly looks a different shape, or is red, hot and swollen without an obvious cause — that combination can indicate Charcot foot, which is urgent.

Contact your diabetic foot service, podiatry team or GP the same day. Out of hours, use NHS 111. Foot infections in diabetes move quickly, and getting seen early is what keeps outcomes good.

Common questions

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