SHOES FOR DIABETICS

Foreword on Diabetes
It is estimated approximately 8.2% of the 28 million population or approximately 2.3million  have diabetes in Malaysia, and this is on the rise. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Second National Health and Morbidity Survey - Diabetes(DIABETES MELLITUS)

Through the Ministry of Health's six year thematic Healthy Lifestyle Campaign which began in 1991, diabetes mellitus was the theme for the year 1995. Here, the promotion of adopting healthy lifestyle practices relating to the prevention of diabetes namely creating awareness and balance diet, maintain ideal body weight and physical activities were encouraged. The campaign also emphasised on creating, awareness of the disease and its complications to the public. Guidelines on management of diabetes and patient education to the diabetes were also developed. In addition, many small studies about diabetes had been conducted either on hospital base or selected communities The first National Health and Morbidity survey included diabetes as a major component in the survey This second National Health and Morbidity Survey, attempted to provide a comparative picture of the epidemiology of diabetes in Malaysia within the last 10 years on a wide population based.

Data on diabetes was obtained from adult respondents 30 years and above through interviews by trained nurses using precoded questionnaires. A 2-hour-post - glucose load test was conducted by the nurses to the respondents who self-professed that they were non-diabetics and have not been diagnosed by any, medical personnel. These non-diabetes were measured for their blood glucose level using glucophotometer in a dry non-wipe technique. 

For the purpose of analysis in this survey, the respondents were categorised into 3 categories. The known diabetes were the adult respondents who self-professed they were diabetics and diagnosed by medical personnel. Those non-diabetics who had undergone the 2 hour - post glucose load test and whose blood glucose measurement level of 11.1 mmol/1 or more were categorised as undiagnosed diabetes. Those with blood glucose measurement of 7.8 - < 11.1 mmol/1 were classified as impaired glucose tolerance (IGT)

From the survey, the national prevalence of known diabetes in Malaysia was found to be 5.7% (5.4% - 6.1%). However, through the 2 hour- post- glucose load test, the national prevalence of undiagnosed diabetes was 2.5% (2.3-2. 7%). Taking into account these 2 categories of diabetes, hence the prevalence of diabetes in Malaysia would be 8.3% (7.8% - 8.7%). From other studies conducted in Malaysia, the prevalence seemed to be on the rise. In 1986, the prevalence of diabetes in Peninsular Malaysia as reported in the first National Health and Morbidity Survey was 6.3% and in 1995 as reported by the Cardiovascular Unit in the Department of Public Health, Ministry of Malaysia was 7.7%.

If estimating the population of Malaysia in 1996 to be approximately 21 million, the total number of diabetic sufferers would approximately be 1.7 million. With further industrialisation plus modernisation, the number of people affected by diabetes may double by 2010. By far, Asia was recognised as having the potential increase with 2.5 to 3 times more common diabetes then it is today. Hence, by 2010, Asia was projected to have 138 million diabetic sufferers.

Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can lead to a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When a wound is not healing, is at risk for infection and infections spread quickly in diabetics.


Prevalence of diabetes in Malaysia was found to be 8.2%. There was an increase in prevalence as compared to the NHMS in 1986, which only reported 6.3% in Peninsular Malaysia.

Information reproduced from The Second National Health and Morbidity Survey II - Diabetes Epidemic in Malaysia was published in 1997 by the Public Health Institute, Ministry of Health, Malaysia


This report is used to primarily focus on the need for diabetes related footwear, an area which is gaining more health focused awareness lately.

Diabetes Footwear

When a diabetic's  foot becomes numb, it may be at risk for deformity. One way this happens is through ulcers. Small, unattended cuts become open sores, which may then become infected. Another way is the bone condition CharcotFoot. This is one of the most serious foot problems diabetics face. It warps the shape of the foot when bones fracture and disintegrate, and yet, because of numbness there is no pain, and the individual continues to walk on the foot. Our practice can treat diabetic foot ulcers and early phases of Charcot (pronounced "sharko") fractures using a total contact cast and prevent more serious damage or deformity. This treatment allows the ulcer to heal by distributing weight and relieving pressure. For Charcot Foot, the cast controls foot movement and supports its contours. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts, and nail discoloration.

Need for Diabetic Shoes?
Proper footwear is an important part of an overall treatment program for people with diabetes, even for those in the earliest stages of the disease. If there is any evidence of neuropathy, or lack of sensation, wearing the right footwear is crucial. Peripheral Neuropathy is a common side effect of diabetes which causes loss of sensation in the extremities. Ill-fitting shoes which rub or pinch the feet excessively can lead to ulceration and foot injury, simply because the diabetic does not feel the injury until it is too late.


Properly fitted diabetic shoes are very important in preventing such injuries. Companies specializing in pedorthics -- the design of footwear and specialty insoles to help alleviate and/or prevent foot pain and injury -- manufacture special shoes and insoles for diabetics. Diabetics must have their shoes custom fitted by a trained professional, since they may not be able to feel an improper fit, due to peripheral neuropathy. By ensuring proper fit and good air circulation, properly designed diabetic shoes and insoles prevent pressure ulcers, encourage good blood circulation, and allow the skin to breathe.

Diabetic shoes are often wider and deeper than regular shoes, to make room for special diabetic insoles. Pedorthic insoles for diabetics are generally custom made for the patient's feet, to ensure proper fit and minimize rubbing and uneven weight distribution, preventing injury. It is also important for a diabetic to have shoes with good air circulation, meaning a lot of diabetic footwear features fabric or sandal-style uppers.

DIABETICS SHOES

Choosing A proper shoe for Diabetics

Diabetic Shoes need to have a breathable construction - WALKABOUT® DIABETIC SHOES'  use of MICROFIBER material is good for this.

Deep and wide designs that allow room for custom interchangeable pedorthic insoles.

Allows Interchangeability of Insoles

Designs with no interior seams (or covered seams) to prevent rubbing injuries.

Diabetic Shoes need a roomy "toe box" to prevent pinching or squeezing of the toes
.

Elastic or easily adjustable fit, to prevent the diabetic shoe from sliding around on the feet.Fitted with the performance PORON insole that absorbs Stepshock .


Orthopaedic Research Laboratories (ORL) in Cleveland, Ohio, (http://orl-inc.com/ ,http://www.footshox.com/ ) recruited patients involved in an exercise research program at the Arthritis Research Institute in the US, to test PORON's shock absorbing insoles. All the patients suffered from foot pain and joint pain caused by osteoarthritis and other forms of arthritis. After a month's usage of PORON insole, 95% of the patients in the test said their foot pain and joint pain was eliminated or reduced and 85% felt less fatigued.

Their findings is illustrated in the stress chart t below.

STRESS CHART

Stepshock (What You Need To Know )
Each step you take generates a jarring force 50 percent greater than your body weight. We call this painful impact “step shock.” The average person walks as many as three to four miles everyday on hard surfaces. Incredibly, the feet of a 165-pound man bear a cumulative weight of 660 tons a day! Women who wear high heels endure even more foot pain than men. That's because wearing high heels doubles the weight borne by the ball of the foot. No wonder millions of people experience foot pain. Step shock has been proven by sports medicine to be the leading cause of foot pain.

Unfortunately, step shock doesn’t stop at your feet. The pain-causing shock waves travel upward into your knees, hips and back, which causes knee pain, hip pain, backache and back pain.

No part of your body needs more protection from pressure and impact than the soles of your feet. That’s the reason the skin on the bottom of your feet is thicker and denser than on the rest of your body. The fatty pads on the soles of your feet are your natural shock absorbers. After enduring years of step shock, your natural shock absorbers begin to thin and wear out. So, you suffer more foot pain as you get older. You have to replace the natural shock absorbers on the bottom of your feet after years of wear and tear – just like you have to replace your car’s shock absorbers after a certain number of miles.

As we get older our feet lose some of the natural cushioning that absorbs the impact of walking. This “step shock” can travel up legs and spine causing pain and discomfort in the feet, knees, hips, back and even be the cause of headaches. This “step shock” is likely to occur in patients that have arthritis, diabetes or sensitive feet. With PORON insole, the problem of stepshock is effectively neutralised.



PORON® Performance Insoles
PORON® Performance Urethanes- High performance cushioning materials for multiple footwear and fashion applications PORON® Urethanes are available in a wide variety of colors, thicknesses, densities and surface textures to accommodate almost any activity, from everyday use to the rigorous demands of high-impact sports and exercise. And if the precise PORON material doesn't already exist, one can be custom formulated for the needs of a specific manufacturer's physical and aesthetic requirements. Maximum retention of comfort and flexibility PORON urethanes are made without plasticizers, which means the material will not shrink or become brittle and crack with age. PORON urethanes retain "like-new" softness and flexibility. The highest degree of impact absorption More shock absorption means less impact to feet and joints. In side-by-side drop weight tests, PORON materials outperformed vinyl sponge, neoprene sponge, sponge rubber, latex foam and solid viscoelastic. A breathable layer to help feet stay dry and cool PORON urethane materials form permeable layers that draw water

PORON' BALL BEARING DROP TEST

For people with diabetes walking can be especially beneficial to health. In addition to lowering cholesterol and decreasing the risk of cardiovascular disease, walking for diabetic exercise also lowers blood sugar level and improves circulation to the legs and feet. As a diabetic walker, you will need to pay careful attention to preventing foot problems such as blisters and calluses and Stepshock. Walk-related foot injuries tend to occur when a walker wears a shoe that is either the wrong type of shoe, improper insole or a poor fit for their feet. Fortunately, most diabetic foot problems can be prevented by purchasing a pair of properly fitting diabetic walking shoes and paying proper attention to diabetic foot care.

PORON PERFROMANCE CATALOGUE

PORON URETHANES TYPES

PORON URETHANES CHARACTERISTICS AND  APPLICATION

The shoe design also incorporates COOLMAX advanced insole lining, which is structured to speed up evaporation, without retaining moisture or perspiration, and actively resists mildew and odours. It is an international trademark product of the highest accepted norm.

Workout clothing, shoes and socks are made of synthetic or occasionally a natural/synthetic blend. These polyester-based fabrics - Coolmax, Dri-Fit and Capilene - are designed to pull perspiration off your skin and help it evaporate or be absorbed by the next layer. This way, your skin is drier and less likely to chafe, and in the case of your feet, to blister. In cold/wet weather, it’s very important to stay as dry as possible.

Coolmax products are designed to wick away perspiration [and] insulate and or vent when you generate too much heat.

WALKABOUT® Diabetics Shoes

Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high pressure areas, and therefore reduce the occurrence of related problems.

Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock (Stepshock), on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear. This is done by using the award winning and tested PORON insole designed by Rogers Corporation, USA with over 177 years of innovation expertise. PORON insoles are recognised and certified by the American Podriatic  Medical Association (APMA).


Accommodate, Stabilize and Support Deformities. Deformities resulting from conditions such as Charcot-Marie-Tooth, fat pad atrophy, hammertoes and amputations must be accommodated. Many deformities need to be stabilized to relieve pain and avoid further destruction. In addition, some deformities may need to be controlled or supported to decrease progression of the deformity.

Limit motion of joints. Limiting the motion of certain joints in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot.

Material composition of WALKABOUT® Diabetics shoes

In achieving proper shoe fit, both the shape and size of the shoe must be considered. You should try to match the shape of the shoe to the shape of your foot. This means that you should be sure your shoes have adequate room in the toe area, over the instep, and across the ball of the foot, and there should be a snug fit around the heel. When considering your correct shoe size, remember that the width is just as important as the length. The proper shoe size is the one where the widest part of the foot, which lies across the foot at the base of the toes, is in the widest part of the shoe. There should also be 3/8 to 1/2 inch between the end of the shoe and the longest toe. In addition, a shoe with laces is recommended to provide the adjustability needed for any swelling or other deformities and to allow the shoe to be fit properly without any danger of slipping off.

Shoe Upper
The upper material of the  WALKABOUT® Diabetic Shoes is of water-resistant micro fiber  which will remain soft & supple. It does not turn brittle or crack like other syntactic materials. The whiteness will remain same for a long period of time.

Micro fiber is durable and has a good anti peeling strength. A microfiber is a fiber which is thinner than a denier i.e. almost 10 times thinner than a strand of hair. They are made up of high quality materials which give it a very smooth finish.

There are many advantages of using microfiber sheets. They are durable and very easy to clean and available in a wide variety of colours and designs so that you can choose one according to your needs.  Microfiber is typically made up of a combination of nylon and polyester which makes it very easy to care for. It can be washed in the washing machine and they retain their shape and sheen forever. The combined strength of the fibers makes microfiber sheets very strong and difficult to tear.

Microfiber is stain resistant and therefore you can easily use them without worrying about stains and spills and wear and tear. Another big advantage of microfiber sheets is that they are resistant to dust, pollen, and dust mites and other allergy causing materials.

It also has longer shelf life and this augurs well for stockists.

UPPER LINNGMicro Fiber and nylon are used as upper lining. The lining are well padded with PU foam to enhance comfort during wear and durability.

OUTSOLE
The outsole is made of 100% natural rubber, which is durable, slip resistant, noise free and also absorbs a certain percentage of STEP SHOCK.

Rubber-soled shoes are performance-oriented, for specific sports or casual occasions. Rubber-soled shoes were first designed for mountain climbing. In 1936, Italian mountain climber Vitale Bramani developed the rubber sole, influenced by the Pirelli automotive tire. The rubber sole was designed for traction. The Vibram Company continues to be a leading manufacturer of rubber soles today.

Podiatrist Arnold Ravick of the American Podiatric Medical Association states a typical men's leather sole weighs about five pounds compared to the 2-1/2 pound rubber sole. Running shoe soles weigh only 10 ounces, on average. 

Rubber soles absorb a greater amount of shock due to their flexibility. Podiatry is the branch of medicine devoted to the diagnosis and treatment of disorders, diseases and injuries of the foot, ankle, and lower leg. Podiatrists, also known as doctors of podiatric medicine (DPMs), treat ankle and foot injuries, deformities and infections including corns, calluses, ingrown toenails, bunions, heel spurs, arch problems, heal pain, and diabetes foot care.

Podiatrists use several techniques to evaluate and treat these problems including prescribing drugs and physical therapy, ordering x-rays, analyzing patients’ walk and weight distribution, setting fractures, fitting corrective shoe inserts called orthotics, designing custom-made shoes, and performing podiatric surgery. More about Dr Arnold Ravick refer to our  posts on the side bar.

Pellicoz Engineering Sdn Bhd which has the rights to claim on the brand  WALKABOUT®,  through its synergy with designers, experienced footwear makers and through its collaberation with the innovation company Rogers Corporation has formulated an ideal shoes for the Diabetics. Contrary to popular belief that the cost is a put off,   WALKABOUT® shoes are within reach to the general public.  Owing to its sound knowledge  of the local environment, no animal skins are used in the manufacture of its medical shoes.

Accepted by APMA

WALKABOUT® PORON insole are guaranteed to last the lifespan of the shoe. 

PORON Guarantees