Shoe gear for the insensitive foot.

People with insensitive feet have lost most of the natural mechanisms that the rest of us use to protect our feet from injury. With normal sensation, we feel discomfort which causes us to change our gait pattern or to remove our shoes. These incidents which seem so minor are the exact occurrences which are unfelt by the insensate person and are responsible for the vast majority of foot injuries. Since these patients cannot tell where injury is occurring, precise shoe fitting is essential. Also, to effectively maintain the insensitive feet intact, additional objective evaluations should be included during the examination of these patients. Shoe pressure testing and thermometry help to identify regions of excessive pressure on the foot before ulceration occurs. A person with sensory loss in the foot often does not seek consultation for foot care until an open wound or neuropathic fracture is already present. These people need a regular schedule of prophylactic management. Their shoes need to be prescribed and worn, not after an ulcer has occurred, but to prevent it from ever forming.