In September 2022, we played a recording of a presentation by Joe Ponsi, of Ponsi’s, in Pittsburgh, who spoke about his 40-year experience as a Podorthist. He talked about the importance of proper shoes and proper fitting.
The above link includes:
- a recording of Ponsi’s presentation that was first given in June 2022 at the Pittsburgh Area Peripheral Neuropathy Support Group (thank you, Bill Wilshire). It was edited to make it easier to see details.
- Dealing with foot ulcers
- Use of hiking shoes for extra side-to-side support
- Lengthy discussion about Foot Drop that goes into some detail about devices to compensate for foot drop by keeping the toes up while retaining foot flexibility (specifically, Foot Ups and Walk-On Flex) AND ways to minimize fall risk by avoiding shoes that are too “grippy” (by buying shoes that are “down”, that is, have “negative heel rocker” with up-turned toe boxes).
The group’s discussion about PN pain will be published later as a separate video.
Here are some notes from that meeting:
- Characteristics of “good” shoes for people with Neuropathy:
- Big wide toe box with ample room beyond the toes (3/8 to 1/2 inch beyond the longest toe)
- Materials made to expand to accommodate foot swelling
- Inserts (or orthotics) that can be changed and will show areas of stress and excess pressure.
- No stitching inside the tops of shoes (that could cause ulcers)
- Deep design (high-profile) to accommodate orthotics
- Get shoes properly fitted by a knowledgeable technician (don’t purchase online)
Shoes should not need a “break in” period, said Ponsi. They should feel good to wear right out of the box. On the other hand, for the good of the shoes, treat them kindly at the beginning. Put them on for a few hours each day for the first several days.
Any neuropathy in the legs and feet can make you unable to detect damage to your feet and toes. That is especially relevant for patients with diabetes, which often makes it hard to control any ulcers that form on the feet (in the video, two of our members discussed their current struggles with foot ulcers). So, it is a good idea, once the numbness in the feet gets severe, to get shoes designed specifically for diabetic patients. There is a standard for such shoes, called A5500.
Medicare says that patients with diabetes who are diagnosed with neuropathy can get their diabetic shoes (A5500 type) paid for by Medicare. But only if they have diabetes.
Any shoe specifically designed to protect your feet from the dangers of neuropathy will have removable inserts. Orthotics are examples of inserts. They can be customized to your individual foot. They are generally made of composite materials. They usually include a top layer of Plastazote that is specifically designed to conform to your foot and, in the process, help diagnose problems by showing pressure points. Some are multi-layer, often with a middle shock absorbing layer made of Poron. Prices and durability range widely. Visits with specialists like Joe can gradually help move the patient move into shoes with the best trade-offs of function, price and durability.
Ponsi mentioned several good brands of diabetic shoes: Apis, Dr. Comfort, Kuru, Propet, Orthofeet, On Cloud, Apex, New Balance, Xelero Genesis, and Brooks.
He emphasized that once neuropathy is severe enough to reduce pain detection in the feet, it was important to protect the feet by never walking barefoot, even in the house. He recommended slippers by Drew Comfy and Spenco.
The one brand of non-diabetic shoe he discussed is Kybun. Unlike the diabetic shoes, it has a very deep layer of cushioning that some of his patients like to relieve foot pain. They are expensive and can hard to find. One of our members use them and love them. Another found them too “grippy” and could not wear them. Because of their soft nature, there was speculation that they would be risky for patients already experiencing balance issues.
Several of the members suggested shopping at stores that specialize in running if you do not specifically need diabetic shoes.
It is important to check your feet daily for trouble signs. Prevention is the key before ulcers occur. Have someone check your feet or buy an inexpensive mirror and place it on the floor. Look for redness or dark areas.
A doctor can measure your level of neuropathy (sensitivity to touch) with a Semmes-Weinstein test that uses little monofilament plastic wires to touch your toes just strongly enough to make the wire bend a little. If you can feel the fine ones, your sensitivity is still good. If you cannot feel the thicker ones – time to start wearing slippers in the house, checking your feet regularly and looking for those diabetic shoes. Unfortunately, many doctors never bother to check. Because awareness of PN is so low in our society, it is not included as part of a standard annual medical checkup. Even if they do, this test will not find neuropathy early.
Bill Porter recommends wearing white socks whenever possible to easily detect blood spots caused by puncture wounds or ulcers that you can’t feel.