Footwear and Orthoses for People with Diabetes

This chapter discusses how to approach the prescription of shoes for patients living with diabetes. The terms ‘insole’ and ‘foot orthosis’ are often used interchangeably, although an orthosis usually implies that some custom attempt to impact the function of the foot has been implemented. Orthoses for patients with loss of protective sensation (LOPS) should usually be ‘accommodative’ rather than ‘corrective’. With respect to orthoses it should also be remembered that the ‘stock’ insoles delivered with most therapeutic shoes are meant only as a filler and usually need to be replaced before footwear is provided to the patient. Patients with LOPS report 15‐fold more injuries during walking or standing than do diabetic patients without LOPS. The reason for this balance problem is that balance is dependent on three inputs about body position in space: proprioception from the feet, vision, and vestibular.