🥿 The Role of Custom Orthopedic Footwear in Preventing Diabetic Foot

Why I Talk So Much About Shoes in My Consultations

I’m Dr. Adrián Lambraño, an orthopedic surgeon specialized in the prevention and integral management of diabetic foot.

If you’ve ever been to my office, you’ve probably noticed something: I always end up checking your shoes.

Why?
Because I know that a shoe can be the starting point of an ulcer… or the barrier that prevents it.

We know that diabetic foot—ulcers, infections, gangrene—is one of the most feared complications of diabetes. Between 4% and 10% of people with diabetes develop foot ulcers, and the lifetime risk can reach 25%. In about 85% of cases, these ulcers precede a lower-limb amputation.

With numbers like these, it’s easy to think only about surgery, antibiotics and hospital stays. But very often the story begins much earlier, with something as everyday as a poorly chosen shoe.

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1. Why Footwear Matters So Much in Diabetic Foot

The core problem comes down to three factors that we see over and over again in studies and in clinical practice:

1. Neuropathy
   The protective sensation in the feet is lost. The patient doesn’t feel pain even when a shoe is rubbing or putting pressure on a specific area. Up to 50% of people with diabetes may develop neuropathy.

2. Foot deformities and altered biomechanics
   Claw toes, bunions, prominent metatarsal heads and other deformities change the way the foot bears weight. This creates high-pressure points that lead to calluses and, underneath those calluses, ulcers.

3. Ischemia (poor circulation)
   When blood flow to the foot is reduced, any small wound heals slowly and is more likely to get infected.

A classic paper on diabetic foot summarizes it clearly: successful treatment of diabetic foot ulcers depends, among other things, on reducing high plantar pressures (offloading), debriding the wound and managing infection and ischemia properly.

And what does footwear have to do with all this? Everything.
Appropriate footwear is one of the most powerful tools we have to reduce those pressures and prevent a deformity or small friction spot from turning into an ulcer.

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2. What Exactly Is Custom Orthopedic Footwear?

When I talk about “custom orthopedic footwear”, I don’t just mean a comfortable shoe.

I mean a shoe that has been:

• Designed based on your specific anatomy (using a mold or foot scan).

• Built with enough depth and width to accommodate the foot without squeezing the toes or bony prominences.

• Equipped with orthopedic insoles or offloading devices that redistribute pressure away from high-risk areas (for example, under a previous ulcer site or a prominent metatarsal head).

• Made with soft internal materials, with no harsh seams, to minimize friction.

In the most advanced care models, this type of footwear is designed collaboratively by the orthopedic surgeon, podiatrist and orthotist/prosthetist, all of whom are part of modern multidisciplinary diabetic foot teams. In countries like the UK, specialized diabetic foot services routinely include orthopedists, diabetologists, podiatrists and orthotists in the same team.

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3. What the Evidence Tells Us About Footwear and Prevention

Research on diabetic foot has consistently shown that:

• Foot deformities, trauma and inappropriate footwear are key factors in the development of ulcers.

• Removing calluses and managing pressure on the sole of the foot are essential steps in ulcer prevention.

• Therapeutic footwear in the presence of deformities is considered a core prevention strategy, especially when combined with patient education and close follow-up.

On top of that, guidelines and national audits stress that diabetic foot should be managed by multidisciplinary teams (diabetology, podiatry, vascular surgery, orthopedics, orthotics and physiotherapy). When this integrated approach is applied properly, centers report a significant reduction in amputation rates.

In other words: footwear alone isn’t everything—but without appropriate footwear, it becomes much harder to prevent ulcers and amputations.

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4. When Do I Recommend Custom Orthopedic Footwear?

In my practice, I usually suggest custom orthopedic footwear in the following situations:

1. History of a previous ulcer
   If you’ve already had a foot ulcer that has healed, we know from studies that the risk of recurrence is high. Protecting that area with targeted offloading through insoles and special footwear becomes a priority.

2. Neuropathy + visible deformities
   If you don’t fully feel the sole of your foot and you also have claw toes, bunions or marked bony prominences, your ulcer risk increases several times.

3. Stable Charcot foot
   In patients with Charcot neuroarthropathy (severe deformity of the foot caused by neuropathy), fully custom orthopedic footwear is essential to prevent new bony collapse and ulcers over the highest pressure areas.

4. Conventional shoes simply don’t fit
   Some feet just don’t “fit” into standard shoes: very wide feet, significant deformities, partial amputations, etc. Insisting on commercial footwear in these cases almost always ends in wounds. Moving to made-to-measure footwear is an investment in health, not just an expense.

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5. How to Choose Good Shoes If You Live With Diabetes

Even if you don’t need fully custom shoes, every person with diabetes should pay attention to these basics:

• Wide toe box
  You should be able to move your toes without feeling them squeezed.

• Enough depth
  Especially if you use insoles, the shoe must have enough “ceiling” to accommodate them without crushing the foot.

• Soft or seamless interior
  Any hard edge or seam can become a friction point.

• Firm heel counter
  The heel should be well held in place, not slipping inside the shoe.

• Stable sole
  Not extremely soft (it deforms and concentrates pressure) and not rock-hard either; ideally with some cushioning.

• Adjustable closure
  Laces or Velcro to adapt to mild swelling throughout the day.

And one piece of advice I repeat constantly:

Don’t trust the number on the label—trust how your foot feels inside the shoe, and what we see when we check it together.

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6. Common Mistakes I See in the Clinic

Here are some of the most frequent mistakes I encounter in my diabetic patients:

• “Doctor, I bought these shoes because they’re stylish; they’ll soften over time.”
  If the shoe hurts on day one, it’s not the right shoe. A diabetic foot cannot afford to “break in” footwear by creating blisters.

• Wearing open sandals or flip-flops
  They expose the foot to trauma, stones and sharp objects, and they make the foot slide, creating friction.

• Buying shoes in the morning
  Feet are usually less swollen in the morning. It’s better to try on shoes at the end of the day, when your feet are at their largest size.

• Keeping worn-out footwear
  A deformed shoe loses its ability to distribute pressure and becomes a risk factor.

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7. How We Approach Footwear in My Practice

In my clinic, footwear is never a minor detail:

1. I watch how you walk and assess your biomechanics.

2. I inspect your current shoes inside and out, looking for worn or deformed areas.

3. When needed, I work together with podiatrists and orthotists to design custom insoles and footwear for you, as recommended by multidisciplinary diabetic foot clinic models.

4. Finally, I teach you how to check your feet and shoes at home, because prevention happens every day, not just in the consulting room.

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📣 My Invitation to You

If you live with diabetes, I want you to remember this key idea:

The shoes you choose today can be the difference between a healthy foot and a future ulcer.

💬 I invite you to:

• Leave a comment and tell me: have you ever had wounds or blisters because of your shoes?

• Share this article with someone who has diabetes and still doesn’t think footwear is important.

📞 And if you’re not sure whether your shoes are right for you—or you’ve already had ulcers in the past—you can book a consultation with me. We’ll review your feet, your gait and your footwear, and if necessary, we’ll design together a custom orthopedic footwear strategy to protect your steps.

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🧑‍⚕️ About the Author

Dr. Adrián Lambraño Hernández is an Orthopedic Surgeon and Traumatologist specialized in the prevention and comprehensive management of diabetic foot. He trained as a physician and orthopedic specialist at the Universidad Militar Nueva Granada in Colombia and has worked in high-complexity hospitals, as well as participating in international training programs focused on diabetic foot limb salvage.

He currently cares for patients in the Tolima region and also offers online consultations, making specialized care more accessible to people from different areas. His mission is to help you preserve your mobility, independence and quality of life, combining the best available scientific evidence with clear, compassionate communication. He firmly believes in the power of patient education, multidisciplinary teamwork and the proper use of tools such as custom orthopedic footwear to prevent ulcers and avoid unnecessary amputations.