Shoes for Diabetic Feet UK: NHS Guidance and What to Buy

Diabetes can cause two serious complications that directly affect the feet:

• Peripheral neuropathy: damage to the nerves in the feet, leading to loss of sensation. This means cuts, blisters, and pressure sores can develop without being noticed.
• Peripheral arterial disease: reduced blood flow to the feet, which impairs healing and increases the risk of infection.

Together, these complications make foot injuries far more dangerous for people with diabetes. The statistics are stark: the NHS carries out approximately 135 diabetes-related amputations per week in England alone. Many of these are preventable with proper footwear, regular foot checks, and early intervention.

The right shoes are not a luxury for people with diabetes; they are a frontline defence against serious complications.

NICE guideline NG19 (Diabetic Foot Problems: Prevention and Management) sets out clear recommendations for footwear. According to these guidelines, suitable shoes for people with diabetes should feature:

• Seamless interior: no internal seams, stitching, or rough spots that could rub against the skin and cause blisters or ulcers.
• Extra depth: sufficient internal volume to accommodate swelling and orthotic insoles without compressing the foot.
• Firm heel counter: a structured heel cup that holds the foot securely in place and prevents excess movement.
• Wide toe box: enough room for toes to lie flat without overlapping, particularly important for people with bunions, hammer toes, or other deformities.
• Removable insole: allows replacement with custom diabetic orthotics prescribed by a podiatrist.
• Lightweight, breathable materials: soft leather or modern technical fabrics that reduce moisture build-up and the risk of fungal infections.

NHS podiatry services categorise diabetic foot risk to determine the appropriate level of footwear intervention:

• Low risk: normal sensation, good blood flow, no deformities. Standard wide-fit shoes with the features listed above are generally adequate. Annual foot checks recommended.
• Moderate risk: some loss of sensation or reduced blood flow, or presence of foot deformities. Specialist footwear is recommended, and an NHS podiatry referral is appropriate. Foot checks every 3 to 6 months.
• High risk: significant neuropathy, peripheral arterial disease, previous ulceration, or amputation. Bespoke therapeutic footwear prescribed and fitted by an NHS orthotist. Foot checks every 1 to 2 months.

When choosing shoes for diabetic feet, look for the following specific features:

• No internal seams: seams create friction points that can break down fragile skin. Look for seamless linings or bonded constructions.
• High, wide toe box: the toe area should be both wide and tall to prevent pressure on the tops of the toes, which is critical for people with claw toes or hammer toes.
• 20mm+ internal depth: extra depth accommodates swelling (which can fluctuate throughout the day) and orthotic insoles.
• Adjustable upper: Velcro straps, laces, or hook-and-loop closures allow the fit to be adjusted as swelling changes during the day.
• Cushioned sole: shock-absorbing midsole material reduces impact forces on vulnerable feet.
• Lightweight construction: under 500g per shoe where possible, to reduce fatigue and make walking easier.

• Cosyfeet: extra-roomy footwear designed in the UK with input from healthcare professionals. Seamless linings, removable insoles, and widths up to 6E. Extensive range including slippers, outdoor shoes, and boots.
• DB Wider Fit: British manufacturer offering widths up to 8E. Many styles specifically designed for diabetic feet with seamless interiors and extra depth. Strong range of men's and women's styles.
• Sandpiper: specialist in extra-wide and extra-deep footwear. Designed for medical needs including diabetes. Soft, stretch uppers that accommodate swelling and deformities.
• Padders: wide-fitting shoes up to 6E with cushioned footbeds and removable insoles. Long-established UK brand with good availability in high-street retailers.
• Hotter: mainstream comfort brand with removable insoles and cushioned footbeds. While not specifically marketed for diabetes, many styles meet the criteria for low-risk diabetic footwear.
• Orthofeet: designed specifically for medical conditions including diabetes. Features include seamless interiors, orthotic insoles, and wide, deep toe boxes. Available online in the UK.

The NHS recommends that people with diabetes carry out daily foot checks. This is particularly important because neuropathy can mean injuries go unnoticed. Each day, check for:

• Cuts, blisters, or grazes
• Swelling or changes in shape
• Changes in skin colour (red patches, bruising)
• Hot or cold spots
• Dry, cracked skin (especially on the heels)
• Signs of infection (warmth, redness, discharge)

Additional footwear guidance from the NHS:

• New shoes should be worn for a maximum of 1 hour initially, then checked for pressure marks before wearing for longer periods.
• Never walk barefoot, even at home. Always wear supportive slippers or house shoes to protect against injury.
• Check inside shoes before putting them on for foreign objects, rough linings, or collapsed insoles.

Several NHS and charitable services can help with diabetic foot care and footwear:

• GP referral: your GP can refer you to NHS podiatry services for foot assessment and, if needed, prescription of specialist footwear or orthotics.
• Diabetes UK helpline: offers advice and support on all aspects of diabetes management, including foot care. Available on 0345 123 2399.
• Multidisciplinary foot teams: NHS trusts operate specialist foot teams combining podiatrists, orthotists, vascular surgeons, and diabetes specialists. These teams manage moderate and high-risk patients.