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Do Diabetic Socks Actually Reduce the Foot Problems Associated with Diabetes

More Effectively than Ordinary Socks?

 

Adam Porter

Psychology 268

Vanderbilt University

September 20, 2006

 

 

 

 

 

 

Introduction

 

            If you are diagnosed with diabetes, chances are you have come across one of the numerous websites that promotes special diabetic socks intended to improve the overall health of your feet.  But how are these socks different from ordinary cotton socks that could be purchased at any retail store?  In this paper we will look at the reasons why diabetics are more prone to foot problems, examine the differences between the construction of the two different types of socks, look at website, personal, and medical reviews, and then conclude with an examination of the scientific research concerning which type of footwear is actually best for the diabetic’s foot.

What causes foot problems in diabetics?

            According to the American Orthopaedic Foot and Ankle Society, there are two main reasons why people with diabetes must be especially careful when it comes to the health of their feet.  The first problem many diabetics face is called neuropathy, or nerve damage.  The Podiarty Channel defines diabetic neuropathy as “a condition in which nerve function deteriorates in the body’s extremities” and “leads to a gradual loss of feeling in the hands, arms, legs, and feet” (www.podiartychannel.com).  This loss of feeling leads to decreased ability to realize the severity of foot related injuries.  By failing to quickly respond to minor cuts, bruises, or blisters, the injury could quickly become infected and lead to serious health conditions.  According to a 2001 study by Bowker and Pfeifer, “a large percentage of diabetic patients undergo nontraumatic amputation after diabetic neuropathy renders them unable to feel festering foot injuries.”  The study also found that within three years of the first amputation, around fifty percent had to undergo a second operation, and “within five years, as many as 80% [had] died.” (Bowker 2001).      The second major problem many diabetics must face is poor circulation.  Diabetes causes the body’s arteries to become blocked and hard, thus limiting the amount of oxygen, nutrients, and blood that can be transported throughout the body.  When an injury occurs, this is extremely hazardous because it reduces the body’s ability to quickly respond and heal the damage. 

Will wearing certain types of socks reduce these risks?

            In order to tackle this question, we must first look at the composition of the two different types of footwear.  Regular 100% cotton or wool socks are criticized for being too tight on the foot and thus reducing circulation.  Additionally, many argue that the coarse seams may rub the foot too firmly thus causing blisters and calluses to emerge.

            Diabetic socks on the other hand, are made from a combination of cotton, acrylic, nylon, and elastic fibers.  These are designed to maximize comfort and cushioning for the wearer while keeping the foot dry and cool.  But why is that an important step in the prevention of foot problems caused by diabetes? 

What information will I find on the internet?

            Some websites, such as www.gean-edwards.com, claim that synthetic diabetic socks are superior because of their ability to pull moisture from the skin or “store excess body heat and release it back to the wearer when conditions cool down.”  The Definitely Diabetic Black Mountain is one of the many types of socks sold on this website.  This style is composed of 75% Outlast Phase Change Technology fiber, 20% nylon, and 5% elastic.  However the website does not divulge what types of materials the Outlast Phase Change Technology fiber is composed of.  Another diabetic sock vendor, www.TheMedSupplyGuide.com, lists wearing diabetic socks as one of its seven tips for relieving diabetic foot discomfort.  Contrary to this advice, websites such as www.diabetes.org simply advise the wearer to choose regular socks that are comfortable to them.  At www.podiatrychannel.com, “natural fibers (e.g., cotton) are preferable to synthetic fabrics because they are breathable and provide better cushioning.”  So far, it seems as if the majority of the websites promoting diabetic socks also happen to be the same websites which are profiting from their sale.

What are other diabetics saying about these socks?

            At the website www.gean-edwards.com, a group of individuals from the North American Hunting Club were chosen to test the Black Mountain Definitely Diabetic socks, just one of their many sock models.  Little information is given about the conditions under which the socks were tested, but dozens of user testimonials are provided to tell the reader what the participants thought about this product.  The quotes range from “After receiving the socks to test, my feet didn't hurt as bad…hunting was bearable and I was able to spend a full day afield instead of half a day.  I even use them at work!” to simply “EXCELLENT!!!”  But the majority of the quotes all seem to have one detail in common.  Most mention comfort as the main reason why they enjoyed and would continue using these special socks.  This would lead one to believe that if one could find a less expensive pair of socks that was comfortable to the wearer, it would work just as well provided that the person wearing the socks still conducted regular foot inspections to check for any abnormalities.  No testimonials against the use of diabetic socks could be found, and thus no user comparisons could be made.

What do doctors and other medical professionals think?

            In the Feldman and Davis study mentioned earlier, researchers conducted what they referred to as an “informal study” of twelve physicians and podiatrists.  The results showed that “sockwear is not a subject about which physicians feel particularly concerned.”  Of the doctors who did make a recommendation, comfort was the most important aspect of choosing what socks to wear.  Nurses were found to be more likely to recommend particular types of material for socks, and suggested cotton or wool rather than the synthetic blends found in specialty diabetic socks.  This was also found to be true for a group of Certified Diabetic Educators.  However, the CDEs were less concerned with comfort, and based their opinions on the ability to keep feet dry. 

What scientific evidence is there?

            Now let’s examine some of the scientific research available on this topic.  A. Veves conducted a study in 1989 that looked at the impact Thorlo socks had on reducing foot pain associated with diabetes.  Their main focus was the increased amount of padding offered by the Thorlo socks.  They concluded that the increased amount of padding helped reduce the formation of foot ulcers when combined with wearing proper shoes.  The following year, Veves found that high-density socks relieved pressure better than regular socks, even after prolonged use.  Another set of studies, led by K.M. Herring and D.H. Richie, looked at the ability of different sock types to pull moisture from the skin.  Their results showed that there was no difference in foot moisture between regularly cushioned generic and acrylic socks.  However, when socks were worn that had increased cushioning, acrylic socks were better at pulling moisture from the skin while regular cotton or wool socks simply absorbed the moisture.  Their conclusion was that diabetics who exercised or worked in conditions where excessive foot moisture was a possibility should wear densely padded acrylic socks to provide maximum comfort while keeping the feet warm and dry.

So what is the final word on diabetic socks?

            After looking at all the different information and claims, it is easy to see how the same person could get a variety of suggestions about what is the best choice of footwear for him or her.  But, after reviewing all of the information a few basic rules seem to be present in nearly all of the articles.  First, all encourage diabetics to wear at least some type of sock and avoid going barefoot or wearing open back shoes or sandals.  Second, white socks are preferable because they allow for maximum visibility of any blood or discharge that may be a result of injuries or calluses on the feet.  Finally, socks should have no uncomfortable cuffs or seams and should not fit too tightly.

            Now for the question at hand: Are diabetic socks better for reducing foot problems associated with diabetes?  Well, the majority of the scientific literature agrees that regular cotton or wool socks will work just as well as special acrylic socks provided that they are comfortable to the wearer and the he or she does regular foot checks to ensure that no injuries are present.  During times of extreme sweat or moisture, diabetic socks do indeed provide an advantage because they are better at pulling away wetness, and therefore leaving the foot dry and reducing the ability of fungi to grow.  So, for everyday use in normal conditions, generic socks are just as effective as the more expensive specialty socks at protecting the feet of those with diabetes.


Works Cited

American Orthopaedic Foot & Ankle Society. (n.d.). Diabetic foot care.  Retrieved September 15, 2006, from http://www.aofas.org/files/public/DiabeticFoot CareEnglishTranslation.pdf.

Bowker, J.H. & Pfeifer, M.A. (Eds.). (2001). Levin and O’Neals The Diabetic Foot. Sixth ed. St Louis, Missouri, Mosby, Inc.

Diabetic foot care, foot problems, sores, wounds, legs, feet. (2006). Retrieved September 17, 2006, from http://www.podiatrychannel.com/diabetes/index.shtml.

Feldman, C.B. & Davis, E.D. (2001). Sockwear recommendations for people with diabetes.  Diabetes Spectrum. 14(2), 59-61.

Guide Media, Inc. (2004). Diabetic socks and foot care. Retrieved September 17, 2006, from http://www.themedsupplyguide.com/diabetic-socks/.

Herring, K.M. & Richie, D.H. (1990). Friction blisters and sock fiber composition: A double blind study. Journal American Podiatry Medical Association. 80, 63-70.

Skrypczak, R. (President). (2006). Diabetic socks. Retrieved September 17, 2006, from http://gean-edwards.com/socks/diabetic.html.

Veves, A. Mason, E.A., Fernando, D.J., & Boulton, A.J. (1989). Use of experimental padded hosiery to reduce abnormal foot pressures in diabetic neuropathy. Diabetes Care. 12, 653-655.

Veves, A. Mason, E.A., Fernando, D.J., & Boulton, A.J. (1990). Studies of experimental hosiery in diabetic neuropathic patients with high foot pressures.

 

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