People with diabetes are predisposed to foot problems because diabetes can damage the nerves (diabetic neuropathy) and reduce blood flow to the feet. For diabetic individuals, well–fitting athletic shoes can mean the difference between a workout that is enjoyable and beneficial and one that results in complications, such as bunions, ulcers, skin infections and osteomyelitis (bone infection).

Many experts recommend that individuals with diabetes buy two pairs of athletic shoes and alternate them each day to help keep feet dry and prevent skin ruptures and blistering.

Shopping for athletic shoes can be overwhelming. However, individuals can take the following steps to ensure the selection of proper–fitting footwear:

• Match athletic shoes to the appropriate sport.
  
  
• Try on shoes after a workout or at the end of the day, when feet are largest.
  
  
• Measure both feet before trying on shoes. Foot size and width typically change four to five times during adulthood. Individuals should therefore have their feet measured every time they buy shoes. Many individuals have one foot that is slightly larger than the other. Select athletic shoes that fit the larger foot to ensure that toes are not cramped.
  
  
• Wear sports socks while trying on athletic shoes to ensure that the shoes are not too small or too narrow.
  
  
• Individuals who wear shoe inserts (the American Diabetes Association recommends using air or silica gel midsoles in athletic shoes) or orthotics (devices that are placed into shoes to alleviate discomfort) should bring them along to test them in various shoes.
  
  
• Try on and compare the fit of at least four pairs of shoes before deciding on a pair.
  
  
• Lace both shoes and walk or jog around the store to ensure a comfortable fit. Shoes that are too loose, too tight or do not fit properly in the heel area can cause blisters, calluses and even ulcers. Shoes should feel comfortable immediately and allow the feet to “breathe.” Individuals should not attempt to break in uncomfortable shoes.

• Select athletic shoes that are built with a soft, flexible upper material that matches the shape of the foot (e.g., flat foot, high–arched foot) and a smooth interior without any seams that may rub and cause blisters.
  
  
• Select shoes with sufficient toe space. The ball of the foot should rest comfortably in the widest part of the shoe, allowing plenty of wiggle room for the toes. Individuals should allow 1/2 inch (about 1 centimeter) between the tip of the shoe and the longest toe. Patients with deformities such as hammertoes (a condition common to people with diabetes and characterized by toes curling under the feet) may require custom–made shoes with extra depth and additional toe space.
  
  
• Choose shoes that bend in the toe area. Shoes that bend in the arch or midfoot area put extra pressure on the Achilles tendon and heel, especially during high–impact activities such as running.
  
  
• Select shoes with thick soles. Thick soles cushion the feet during physical activity. This additional protection is especially important for individuals with impaired circulation, a common condition in diabetes.

Researchers have found that many patients with diabetic foot wounds have incorrectly sized shoes. Patients who have difficulty finding shoes that fit well or who have foot conditions may benefit from consulting a pedorthist, a medical specialist who fits shoes.