From the Guidelines
For a patient with bilateral bunions who doesn't qualify for custom orthotics, I recommend wide-toe box shoes with good arch support, combined with over-the-counter prefabricated orthotics, as the most suitable option to reduce pressure and accommodate foot deformities without exacerbating pain or progression, as supported by the guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update) 1. The patient's condition, bilateral bunions, requires special consideration when selecting footwear and orthotics.
- Key characteristics of suitable footwear include:
- Wide-toe box to accommodate the bunion deformity
- Good arch support to reduce pressure on the foot
- Low heel (under 2 inches) to minimize strain on the foot
- Soft uppers made of leather or mesh for comfort and breathability
- Adequate depth to accommodate foot deformities without pressure
- Specific footwear options include brands like New Balance, Brooks, Hoka, or Altra that offer "wide" or "extra wide" width options.
- For over-the-counter orthotics, semi-rigid arch supports with metatarsal pads can help redistribute pressure away from the bunion area, as recommended by the guidelines on preventive foot care in diabetes 1.
- Products like Powerstep, Superfeet Green, or Dr. Scholl's bunion cushions provide good alternatives to custom devices, and silicone toe spacers or bunion sleeves can also help reduce friction and pressure on the bunion prominence. The patient's selection of the Apex X521M in size 13.0 and the Cadence insoles in the same size is a suitable option, given the patient's needs and the guidelines provided by the IWGDF 2023 update 1 and other studies 1.
From the Research
Suitable Footwear and Orthotic Options
For a patient with bilateral bunions who does not meet the criteria for custom orthotics, several footwear and orthotic options can be considered:
- Medical shoe options, such as the Apex X521M, which can provide adequate support and comfort for patients with bilateral bunions 2
- Prefabricated insoles, such as the Cadence insoles, which can help reduce pressure on the feet and provide additional support 3
- Shoe modifications, such as a flat heel and a sufficiently thick external sole, which can help limit nerve compression and relieve pain 4
Key Considerations
When selecting suitable footwear and orthotic options, the following factors should be considered:
- The patient's specific foot condition and needs
- The level of support and comfort required
- The patient's lifestyle and activity level
- The potential for shoe modifications or orthotics to alleviate symptoms and improve quality of life 5, 6
Orthotic Options
For patients who do not meet the criteria for custom orthotics, prefabricated orthotics can be a suitable alternative: