When do I need custom diabetic shoe inserts?



Many patients that come into the office are qualifying for one pair of diabetic shoes per year and a lot of patients aren’t really understanding when they should get a normal pair of inserts or when they should get a customized pair of diabetic inserts.  So I want to try to explain the difference to you. Normally with diabetes, you get one pair of shoes and three pairs of inserts per year.  The inserts can either be a regular over-the-counter shelf pair or they can be a customized pair.  The main difference is that an over-the-counter pair of inserts has two densities of material.  That is why they’re called dual density.  The top density is made out of plastazote and it’s the same density as your skin so that as you walk, it does not allow for friction on the bottom of the foot.  The other fabric that’s underneath it is usually a different color and it is a harder density so that can provide more stability and protection. A normal pair that you get with shoes when they’re not customized has these two colors.  You heat them up in a convection oven for a few seconds and then you stand on them to have them mold to your foot.  If you have a normal foot with no real big problems or really big calluses or any amputations, you should be able to use a normal type of an insert.  But, if you do have a foot condition such as a bunion, a hammertoe, a bone that’s further down causing really big calluses, or if you have also had an amputation, you may need different modifications done to these inserts to make them work better.  One of these modifications is an amputation fill. That’s actually where they put a little piece of fabric to allow for separation replacement where that toe was.  Also, if you have really big calluses, you may need to do a special cutout in that harder material underneath to allow that bone to drop down and to accommodate it. So these can only be done with a custom insole, so what you have to do is step in a foam box and these needs to be sent to the lab or they can make a custom diabetic insole for your shoes.  Usually if you have just custom insoles, you get three pairs of them, but if you have an amputation fill you only get one of them for that foot.  You wear these normally with your extra depth diabetic shoes as well.  So that’s the main difference between a custom pair of diabetic insoles and just a regular over-the-counter pair of diabetic insoles. 

To Your Health,
Dr. Donald Pelto